Provider Demographics
NPI:1205316205
Name:URBAN, TANNER (ATC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:URBAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7449 E SUMMERSIDE PL
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-7678
Mailing Address - Country:US
Mailing Address - Phone:620-655-7398
Mailing Address - Fax:
Practice Address - Street 1:7449 E SUMMERSIDE PL
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-7678
Practice Address - Country:US
Practice Address - Phone:620-655-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer