Healthcare Provider Details

I. General information

NPI: 1265091615
Provider Name (Legal Business Name): REBECCA C TANZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 08/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BIG SPRING RD
NEWVILLE PA
17241-9497
US

IV. Provider business mailing address

1615 3RD ST APT 2
ENOLA PA
17025-3280
US

V. Phone/Fax

Practice location:
  • Phone: 717-776-8200
  • Fax:
Mailing address:
  • Phone: 856-417-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT028048
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: