Provider Demographics
NPI:1477641215
Name:TANNAHILL, MARTINA
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:TANNAHILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 PLAYERS CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8844
Mailing Address - Country:US
Mailing Address - Phone:901-685-7227
Mailing Address - Fax:
Practice Address - Street 1:7361 PRAIRIE FALCON RD
Practice Address - Street 2:130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0823
Practice Address - Country:US
Practice Address - Phone:702-804-1511
Practice Address - Fax:702-804-2551
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17912251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics