Provider Demographics
NPI:1942202619
Name:TAHTINEN, DEAN ERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:ERICK
Last Name:TAHTINEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 CHARLEVOIX AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8524
Mailing Address - Country:US
Mailing Address - Phone:231-439-3750
Mailing Address - Fax:231-439-5918
Practice Address - Street 1:2609 CHARLEVOIX AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8524
Practice Address - Country:US
Practice Address - Phone:231-439-3750
Practice Address - Fax:231-439-5918
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4492138Medicaid
MI4492137Medicaid
MI4492137Medicaid