Provider Demographics
NPI:1770853566
Name:TENNANT, AUBREY (DPT)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:TENNANT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4342
Mailing Address - Country:US
Mailing Address - Phone:916-832-0911
Mailing Address - Fax:916-677-1214
Practice Address - Street 1:1650 LEAD HILL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3061
Practice Address - Country:US
Practice Address - Phone:916-677-1210
Practice Address - Fax:916-344-1214
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GL930ZMedicare UPIN