=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487541025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANNER GEORGE HEEREN PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1014 N NOLAN RIVER RD UNIT A
-----------------------------------------------------
City | CLEBURNE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76033-7936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-641-8617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 DIANTHUS DR
-----------------------------------------------------
City | CROWLEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76036-4063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-513-9840
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 132725
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------