Provider Demographics
NPI:1922367838
Name:IUDICE, TANYA (PT,OCS)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:IUDICE
Suffix:
Gender:F
Credentials:PT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OLD SOMERSET AVE
Mailing Address - Street 2:UNIT 2, P.O BOX 1255
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-1824
Mailing Address - Country:US
Mailing Address - Phone:508-822-1135
Mailing Address - Fax:
Practice Address - Street 1:600 OLD SOMERSET AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-1824
Practice Address - Country:US
Practice Address - Phone:508-822-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9414225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic