Provider Demographics
NPI:1821486598
Name:TAN-FERRER, REAH (PT)
Entity Type:Individual
Prefix:MRS
First Name:REAH
Middle Name:
Last Name:TAN-FERRER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REAH
Other - Middle Name:SO
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:930 S. BAXTER
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-595-4668
Mailing Address - Fax:
Practice Address - Street 1:930 S. BAXTER
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-595-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist