Healthcare Provider Details

I. General information

NPI: 1093064909
Provider Name (Legal Business Name): TNA ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 APEX DR
HIGHLAND IL
62249-1282
US

IV. Provider business mailing address

5701 GODFREY RD
GODFREY IL
62035-2471
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-0444
  • Fax: 618-654-5439
Mailing address:
  • Phone: 618-651-0444
  • Fax: 618-654-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM KUSTERMANN
Title or Position: PRESIDENT
Credential:
Phone: 618-651-0444