Provider Demographics
NPI:1508893017
Name:MAIN, TANYA LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:MAIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LYNN
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:PO BOX 3014 MCFARLAND CLINIC PC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-956-4095
Mailing Address - Fax:515-956-4093
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:MCFARLAND CLINIC PC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-956-4095
Practice Address - Fax:515-956-4093
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2431882Medicaid
IA2431882Medicaid