Provider Demographics
NPI:1710640446
Name:TENNEY REHAB
Entity Type:Organization
Organization Name:TENNEY REHAB
Other - Org Name:PAYSON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-978-3234
Mailing Address - Street 1:103 N FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4362
Mailing Address - Country:US
Mailing Address - Phone:928-978-3234
Mailing Address - Fax:
Practice Address - Street 1:405 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5345
Practice Address - Country:US
Practice Address - Phone:928-474-0429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty