Provider Demographics
NPI:1649328238
Name:TJADEN, WILLIAM PETE JR (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PETE
Last Name:TJADEN
Suffix:JR
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 1:2911 GEORGE BUSBEE PKWY NW STE 50
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6910
Mailing Address - Country:US
Mailing Address - Phone:844-328-4624
Mailing Address - Fax:770-882-2576
Practice Address - Street 1:2911 GEORGE BUSBEE PKWY NW STE 50
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6910
Practice Address - Country:US
Practice Address - Phone:844-328-4624
Practice Address - Fax:770-882-2576
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ610640800OtherGROUP OWCP
AZAZ0461720OtherGROUP BCBS
AZ2Z1174OtherHEALTH NET