MEDICARE: TANA IFARINDE PTA

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	225200000X	Physical Therapy Assistant	2085580	TX

General Provider Information

NPI Number	:	1912481326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANA IFARINDE PTA

Provider Business Mailing Address
First Line	:	1015 OLIVIA DR
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-3427
Country	:	US
Telephone Number	:	214-693-8280
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 BARNETT DR
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75077-3176
Country	:	US
Telephone Number	:	469-546-1052
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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Directions to “ TANA IFARINDE PTA” Practice Location

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