MEDICARE: DANIEL TANNENBAUM 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	40QA01386100	NJ
2	225100000X	Physical Therapist	10373	TN
3	225100000X	Physical Therapist	10861	CT

General Provider Information

NPI Number	:	1730486671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL TANNENBAUM PT

Provider Business Mailing Address
First Line	:	499 FARMINGTON AVE STE 300
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1933
Country	:	US
Telephone Number	:	860-549-8986
Fax Number	:	860-284-9630

Provider Business Practice Location Address
First Line	:	499 FARMINGTON AVE STE 300
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1933
Country	:	US
Telephone Number	:	860-549-8986
Fax Number	:	860-284-9630

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

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	03/01/2023

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Directions to “ DANIEL TANNENBAUM PT” Practice Location

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