Healthcare Provider Details

I. General information

NPI: 1962504852
Provider Name (Legal Business Name): RODNEY G. TANK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 WESTFIELD RD
NOBLESVILLE IN
46060-1323
US

IV. Provider business mailing address

2312 S DIXON RD SUITE 250
KOKOMO IN
46902-6401
US

V. Phone/Fax

Practice location:
  • Phone: 317-776-2122
  • Fax: 317-776-2622
Mailing address:
  • Phone: 765-455-2122
  • Fax: 765-455-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05002736A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: