MEDICARE: JOSEPH TANAQUIN PT

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
1	225100000X	Physical Therapist	1691	NV

General Provider Information

NPI Number	:	1932977246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH TANAQUIN PT

Provider Business Mailing Address
First Line	:	4016 SEA HERO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4016 SEA HERO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4401
Country	:	US
Telephone Number	:	702-596-4241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2023
Last Update Date	:	12/15/2023

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Directions to “ JOSEPH TANAQUIN PT” Practice Location

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