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General NPI Number Information
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NPI Number | 1699204370
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Entity Type | Individual
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Provider Name | TANNER JAMES GOODEN PTA
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Gender | Male
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 1901 HOWELL AVE
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City | WORLAND
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State | WY
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Zip | 82401-3733
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Country | US
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Telephone | 307-347-4285
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Fax | 307-347-2154
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Provider Business Mailing Address
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Address Line | 222 S HIGHLAND ST
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City | DU BOIS
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State | PA
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Zip | 15801-2077
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Country | US
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Telephone | 814-771-5619
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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 | TE011221
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License Number State | PA
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