Provider Demographics
NPI:1629115936
Name:HENRY, TANYA M (PT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:M
Other - Last Name:GNEWUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15836 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-1929
Mailing Address - Country:US
Mailing Address - Phone:214-457-8166
Mailing Address - Fax:
Practice Address - Street 1:60 E RIO SALADO PKWY STE 900
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-9126
Practice Address - Country:US
Practice Address - Phone:602-885-9575
Practice Address - Fax:480-718-7657
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-012793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist