Provider Demographics
NPI:1689858896
Name:BEISWENGER, TANYA D (PT)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:D
Last Name:BEISWENGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4901 LACDE VILLE BLVD
Mailing Address - Street 2:STE110 BLDG D- CLINTON CROSSINGS
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14468
Mailing Address - Country:US
Mailing Address - Phone:585-341-9142
Mailing Address - Fax:
Practice Address - Street 1:4901 LACDEVILLE BLVD
Practice Address - Street 2:CLINTON CROSSINGS - STE 110, BLDG D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5647
Practice Address - Country:US
Practice Address - Phone:585-341-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013130-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic