Provider Demographics
NPI:1629288345
Name:IMLER, TANYA M (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:M
Last Name:IMLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 74387
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-4387
Mailing Address - Country:US
Mailing Address - Phone:612-398-1716
Mailing Address - Fax:
Practice Address - Street 1:122 1ST AVE STE 600
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4899
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist