Provider Demographics
NPI:1548728470
Name:TALLEY, TIANNA S (ATC)
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:S
Last Name:TALLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 LANDINGS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7651
Mailing Address - Country:US
Mailing Address - Phone:678-471-9291
Mailing Address - Fax:
Practice Address - Street 1:119 LANDINGS DR STE 204
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7651
Practice Address - Country:US
Practice Address - Phone:678-471-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer