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NPI Code Detail

MEDICARE: TANYA M GOELLER PTA

MEDICARE: TANYA M GOELLER PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant06002369AIN

General Provider Information

NPI Number : 1174720650
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA M GOELLER PTA
Provider Business Mailing Address
First Line : 814 W MISHAWAKA AVE
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-6009
Country : US
Telephone Number : 574-255-1206
Fax Number :
Provider Business Practice Location Address
First Line : 1950 RIDGEDALE RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-2243
Country : US
Telephone Number : 574-291-6722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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Directions to “ TANYA M GOELLER PTA” Practice Location

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