1538364484 NPI number — MRS. TANYA LANAY PETREE P.T.

Table of content: (NPI 1194802710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538364484 NPI number — MRS. TANYA LANAY PETREE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETREE
Provider First Name:
TANYA
Provider Middle Name:
LANAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VINSON
Provider Other First Name:
TANYA
Provider Other Middle Name:
LANAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538364484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 HATCHER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76430-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-762-3735
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 BAIRD HWY 283
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-762-3947
Provider Business Practice Location Address Fax Number:
325-762-3948
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1061711 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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