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General NPI Number Information
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NPI Number | 1255763090
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Entity Type | Individual
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Provider Name | TANIA DECKER
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Gender | Female
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Dates
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Enumeration Date | 08/03/2013
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1911 CAROUSEL CT
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City | JOLIET
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State | IL
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Zip | 60435-7902
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Country | US
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Telephone | 773-213-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 CAROUSEL CT
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City | JOLIET
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State | IL
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Zip | 60435-7902
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Country | US
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Telephone | 773-213-3366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 160.006412
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160006412
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License Number State | IL
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