Provider Demographics
NPI:1811433204
Name:MAURER, TANNA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TANNA
Middle Name:
Last Name:MAURER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:TANNA
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1310 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3452
Mailing Address - Country:US
Mailing Address - Phone:303-772-2255
Mailing Address - Fax:
Practice Address - Street 1:1310 BAKER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3452
Practice Address - Country:US
Practice Address - Phone:303-772-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist