Provider Demographics
NPI:1912481326
Name:IFARINDE, TANA (PTA)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:
Last Name:IFARINDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1015 OLIVIA DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3427
Mailing Address - Country:US
Mailing Address - Phone:214-693-8280
Mailing Address - Fax:
Practice Address - Street 1:112 BARNETT DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-3176
Practice Address - Country:US
Practice Address - Phone:469-546-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085580225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant