Provider Demographics
NPI:1700196805
Name:KORMANN, TANYA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:KORMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:THORNDIKE
Mailing Address - State:ME
Mailing Address - Zip Code:04986-3041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2119
Practice Address - Country:US
Practice Address - Phone:207-594-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 2697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist