Provider Demographics
NPI:1942062336
Name:READ, TATIANNA LEA (PTA)
Entity Type:Individual
Prefix:
First Name:TATIANNA
Middle Name:LEA
Last Name:READ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 W 18TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-7640
Mailing Address - Country:US
Mailing Address - Phone:602-677-8873
Mailing Address - Fax:
Practice Address - Street 1:21576 S ELLSWORTH LOOP RD STE 108
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-1068
Practice Address - Country:US
Practice Address - Phone:602-737-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ014776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant