MEDICARE: HOLLY C TANNER MA, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5549	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650017399	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	133463	OTHER	WA	DEPT OF LABOR & INDUSTRIE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8924971	OTHER	WA	CRIME VICTIMS
5	A006	OTHER	WA	TRICARE
6	TA8702	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1518070655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY C TANNER MA, PT

Provider Business Mailing Address
First Line	:	3417 EVANSTON AVE N
Second Line	:	SUITE 229
City	:	SEATTLE
State	:	WA
Zip	:	98103-8626
Country	:	US
Telephone Number	:	206-858-2914
Fax Number	:	206-732-6544

Provider Business Practice Location Address
First Line	:	3417 EVANSTON AVE N
Second Line	:	SUITE 229
City	:	SEATTLE
State	:	WA
Zip	:	98103-8626
Country	:	US
Telephone Number	:	206-858-2914
Fax Number	:	206-732-6544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	09/02/2015

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Directions to “ HOLLY C TANNER MA, PT” Practice Location

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