Provider Demographics
NPI:1801020615
Name:TANNER, KAREN HOLLOWAY (PTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:HOLLOWAY
Last Name:TANNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-9236
Mailing Address - Country:US
Mailing Address - Phone:252-308-9417
Mailing Address - Fax:
Practice Address - Street 1:188 BISHOP RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-9236
Practice Address - Country:US
Practice Address - Phone:252-308-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2574225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant