Provider Demographics
NPI:1457880338
Name:TALLANT, TIANA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:TALLANT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W UNIVERSITY AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7115
Mailing Address - Country:US
Mailing Address - Phone:928-556-9935
Mailing Address - Fax:
Practice Address - Street 1:906 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2986
Practice Address - Country:US
Practice Address - Phone:928-556-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist