MEDICARE: TENNEY REHAB

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

General Provider Information

NPI Number	:	1710640446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNEY REHAB

Provider Business Mailing Address
First Line	:	103 N FOREST PARK DR
Second Line	:
City	:	PAYSON
State	:	AZ
Zip	:	85541-4362
Country	:	US
Telephone Number	:	928-978-3234
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 W MAIN ST STE D
Second Line	:
City	:	PAYSON
State	:	AZ
Zip	:	85541-5345
Country	:	US
Telephone Number	:	928-474-0429
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JARED TENNEY
Credential	:	PT
Telephone Number	:	928-978-3234

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	11/09/2021

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Directions to “TENNEY REHAB ” Practice Location

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