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General NPI Number Information
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NPI Number | 1417169038
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Entity Type | Individual
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Provider Name | JEFFREY A TANNER MPT
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 HOSPITAL DR
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City | SPENCER
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State | WV
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Zip | 25276-1050
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Country | US
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Telephone | 304-927-6249
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Fax | 304-927-6837
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Provider Business Mailing Address
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Address Line | 42 SNYDERS RUN
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City | GANDEEVILLE
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State | WV
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Zip | 25243-8704
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Country | US
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Telephone | 304-927-6249
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Fax | 304-927-6837
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT001303
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License Number State | WV
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