Healthcare Provider Details

I. General information

NPI: 1326203274
Provider Name (Legal Business Name): TAMYRA LEE JANSEN PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMYRA LEE TOTH PT,DPT

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 BUCHANAN TRAIL EAST
GREENCASTLE PA
17225-8531
US

IV. Provider business mailing address

1580 BUCHANAN TRAIL EAST
GREENCASTLE PA
17225-8531
US

V. Phone/Fax

Practice location:
  • Phone: 717-643-0574
  • Fax:
Mailing address:
  • Phone: 717-643-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT019381
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: