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General NPI Number Information
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NPI Number | 1396220018
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Entity Type | Individual
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Provider Name | EDWIN TANTIANGCO PTA
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Gender | Male
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 100 DELAWARE VETERANS BLVD
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City | MILFORD
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State | DE
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Zip | 19963-5395
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Country | US
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Telephone | 302-424-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 27219 BUCKSKIN TRL
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City | HARBESON
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State | DE
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Zip | 19951-2719
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Country | US
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Telephone | 302-569-0685
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | J2-0001224
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License Number State | DE
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