Provider Demographics
NPI:1134347685
Name:NAZARIO, ANN CHARMAINE TAN (PT)
Entity type:Individual
Prefix:
First Name:ANN CHARMAINE
Middle Name:TAN
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 HAMPDEN BLVD
Mailing Address - Street 2:APT. K7
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1346
Mailing Address - Country:US
Mailing Address - Phone:201-282-7203
Mailing Address - Fax:
Practice Address - Street 1:2125 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-2259
Practice Address - Country:US
Practice Address - Phone:610-921-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018419225100000X
NY028143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist