Provider Demographics
NPI:1013275825
Name:TANNER PT, LLC
Entity Type:Organization
Organization Name:TANNER PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-730-7920
Mailing Address - Street 1:31 W SUPERIOR ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2063
Mailing Address - Country:US
Mailing Address - Phone:218-730-7920
Mailing Address - Fax:218-260-2347
Practice Address - Street 1:31 W SUPERIOR ST
Practice Address - Street 2:SUITE 502
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2063
Practice Address - Country:US
Practice Address - Phone:218-730-7920
Practice Address - Fax:218-260-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5549261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy