Provider Demographics
NPI:1558500470
Name:CONROY, TANJA M (MSPT)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:M
Last Name:CONROY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CHANNING PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2128
Mailing Address - Country:US
Mailing Address - Phone:401-619-3768
Mailing Address - Fax:
Practice Address - Street 1:2974 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4232
Practice Address - Country:US
Practice Address - Phone:401-293-5790
Practice Address - Fax:401-293-5796
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02035225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist