Healthcare Provider Details

I. General information

NPI: 1649566910
Provider Name (Legal Business Name): WILLIAM P TANK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CROSSLAKE DR
EVANSVILLE IN
47715-8198
US

IV. Provider business mailing address

7300 E INDIANA ST SUITE 102
EVANSVILLE IN
47715-2794
US

V. Phone/Fax

Practice location:
  • Phone: 812-471-6677
  • Fax: 812-474-2296
Mailing address:
  • Phone: 812-476-0409
  • Fax: 812-476-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9070
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05010713A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: