Healthcare Provider Details

I. General information

NPI: 1013377266
Provider Name (Legal Business Name): TANYA TEPEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 DECKER LN
CREVE COEUR MO
63141-6710
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD STE 300
SAINT LOUIS MO
63117-1203
US

V. Phone/Fax

Practice location:
  • Phone: 314-656-7578
  • Fax: 314-997-4532
Mailing address:
  • Phone: 314-644-1978
  • Fax: 314-433-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2016005644
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070022017
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: