Provider Demographics
NPI:1720339211
Name:TALLMAN, MAUREEN L (PTA)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18540 MISSOURI 16
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63452
Mailing Address - Country:US
Mailing Address - Phone:573-217-2070
Mailing Address - Fax:573-215-2077
Practice Address - Street 1:18540 MISSOURI 16
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452
Practice Address - Country:US
Practice Address - Phone:573-217-2070
Practice Address - Fax:573-215-2077
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004035094225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant