Provider Demographics
NPI:1679861991
Name:TAN, JOANNE MARIE TIU (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOANNE MARIE
Middle Name:TIU
Last Name:TAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BROADWAY STE 603
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2537
Mailing Address - Country:US
Mailing Address - Phone:212-422-1111
Mailing Address - Fax:212-867-2255
Practice Address - Street 1:65 BROADWAY STE 603
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2537
Practice Address - Country:US
Practice Address - Phone:212-422-1111
Practice Address - Fax:212-867-2255
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038515-1225100000X
IL070017823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist