=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780669762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANAS PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 BAINES CT
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-6625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-380-0964
-----------------------------------------------------
Fax | 919-380-8121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 BAINES CT
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-6625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-380-0964
-----------------------------------------------------
Fax | 919-380-8121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. NABILA S TANAS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 919-380-0964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2825
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------