Provider Demographics
NPI:1326391343
Name:FLEENER, TABITHA (PTA)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:FLEENER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12034 E OAKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-8328
Mailing Address - Country:US
Mailing Address - Phone:812-887-4206
Mailing Address - Fax:
Practice Address - Street 1:12034 E OAKTOWN RD
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-8328
Practice Address - Country:US
Practice Address - Phone:812-887-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004461A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant