Provider Demographics
NPI:1326203274
Name:JANSEN, TAMYRA LEE (PT,DPT)
Entity Type:Individual
Prefix:
First Name:TAMYRA
Middle Name:LEE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:TAMYRA
Other - Middle Name:LEE
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1580 BUCHANAN TRAIL EAST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-8531
Mailing Address - Country:US
Mailing Address - Phone:717-643-0574
Mailing Address - Fax:
Practice Address - Street 1:1580 BUCHANAN TRAIL EAST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-8531
Practice Address - Country:US
Practice Address - Phone:717-643-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0193812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic