Provider Demographics
NPI:1659576346
Name:HUPE, TANYA LEA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LEA
Last Name:HUPE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 EARLYWINE RD
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-7463
Mailing Address - Country:US
Mailing Address - Phone:979-830-5003
Mailing Address - Fax:
Practice Address - Street 1:6525 EARLYWINE RD
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-7463
Practice Address - Country:US
Practice Address - Phone:979-830-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2045284225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant