Provider Demographics
NPI:1346546280
Name:TANI, REBECCA V (DPT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:V
Last Name:TANI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S SUMMIT AVE
Mailing Address - Street 2:388
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-9998
Mailing Address - Country:US
Mailing Address - Phone:301-956-5925
Mailing Address - Fax:
Practice Address - Street 1:21 S SUMMIT AVE
Practice Address - Street 2:388
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-9998
Practice Address - Country:US
Practice Address - Phone:301-956-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD226012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics