Provider Demographics
NPI:1447613294
Name:CHOUDHRY, TANYA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:TANYA
Middle Name:
Last Name:CHOUDHRY
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 1:39 HOPE RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9777
Mailing Address - Country:US
Mailing Address - Phone:908-619-7974
Mailing Address - Fax:
Practice Address - Street 1:200 BRISTOL GLEN DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2329
Practice Address - Country:US
Practice Address - Phone:973-579-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00324700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant