Provider Demographics
NPI:1346677663
Name:FERRERA, TANYA INGEBORG (PT)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:INGEBORG
Last Name:FERRERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:INGEBORG
Other - Last Name:ULLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:642 CHENERY ST
Mailing Address - Street 2:#4
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3078
Mailing Address - Country:US
Mailing Address - Phone:313-333-5949
Mailing Address - Fax:
Practice Address - Street 1:3388 17TH ST
Practice Address - Street 2:#100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-7201
Practice Address - Country:US
Practice Address - Phone:415-553-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic