Provider Demographics
NPI:1710184254
Name:CAMERON, TANYA (PTA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:CAMERON
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 1:6574 CRYSTAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8733
Mailing Address - Country:US
Mailing Address - Phone:317-839-6460
Mailing Address - Fax:
Practice Address - Street 1:255 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1415
Practice Address - Country:US
Practice Address - Phone:317-745-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003024225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant