Provider Demographics
NPI:1760880710
Name:TANGUAY, MICHAEL ROBERT (ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:TANGUAY
Suffix:
Gender:M
Credentials:ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NORTH STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-584-1954
Mailing Address - Fax:954-584-7794
Practice Address - Street 1:450 NORTH STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-584-1954
Practice Address - Fax:954-584-7794
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist