Provider Demographics
NPI:1558559567
Name:DI MARTINO, TANYA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:ANN
Last Name:DI MARTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NE 97TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-9247
Mailing Address - Country:US
Mailing Address - Phone:816-414-5808
Mailing Address - Fax:816-414-5810
Practice Address - Street 1:8121 E HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-3186
Practice Address - Country:US
Practice Address - Phone:816-414-5808
Practice Address - Fax:816-414-5810
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999135776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist