Provider Demographics
NPI:1538364484
Name:PETREE, TANYA LANAY (PT)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LANAY
Last Name:PETREE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LANAY
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 HATCHER ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-2721
Mailing Address - Country:US
Mailing Address - Phone:325-762-3735
Mailing Address - Fax:
Practice Address - Street 1:724 BAIRD HWY 283
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:TX
Practice Address - Zip Code:76430
Practice Address - Country:US
Practice Address - Phone:325-762-3947
Practice Address - Fax:325-762-3948
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist