Provider Demographics
NPI:1861579948
Name:STENHOUSE, TANYA RUTH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:RUTH
Last Name:STENHOUSE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 E WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7234
Mailing Address - Country:US
Mailing Address - Phone:602-790-0151
Mailing Address - Fax:
Practice Address - Street 1:R.B. P.O. 3125
Practice Address - Street 2:PINAL SPECIAL EDUCATION
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-723-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR333831Medicaid