Most Relevant Information
Provider Data
| NPI Number: | 1003678673 |
| Provider Name: | TAN TA |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/29/2024 |
| Last Updated: | 01/29/2024 |
Provider Practice Location
3020 E BROAD ST STE 112
MANSFIELD
TX
760636696
Practice Location Phone/Fax
| Phone: | 6824227580 |
| Fax: |
Provider Mailing Location
3020 E BROAD ST STE 112
MANSFIELD
TX
760636696
Provider Mailing Phone/Fax
| Phone: | 6824227580 |
| Fax: |