Provider Demographics
NPI:1578821138
Name:BIBLE, TANNA JONES (PTA, LMT)
Entity Type:Individual
Prefix:
First Name:TANNA
Middle Name:JONES
Last Name:BIBLE
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6604
Mailing Address - Country:US
Mailing Address - Phone:512-508-3808
Mailing Address - Fax:
Practice Address - Street 1:2717 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6604
Practice Address - Country:US
Practice Address - Phone:512-508-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2068233225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant