Provider Demographics
NPI:1689048654
Name:TANTIANGCO, ARLENE (PT)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:TANTIANGCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:PALACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27219 BUCKSKIN TRL
Mailing Address - Street 2:
Mailing Address - City:HARBESON
Mailing Address - State:DE
Mailing Address - Zip Code:19951-2719
Mailing Address - Country:US
Mailing Address - Phone:302-569-0684
Mailing Address - Fax:
Practice Address - Street 1:17028 CADBURY CIRCLE
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist