Summerill, Tanielle
Summerill, Tanielle is an individual health care provider with primary practice located at 2626 N Wauwatosa Ave , Wauwatosa WI 53213-1137. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Summerill, Tanielle can be contacted via phone (414) 774-7794.Contact Information
Primary practice address
2626 N Wauwatosa Ave
Wauwatosa WI 53213-1137
Phone: (414) 774-7794
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant | 225200000X | 990-019 | Wisconsin |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant | 225200000X | PTA-300 | Idaho |
Profile Details
| NPI number | 1447351564 |
|---|---|
| LBN Legal business name | Summerill, Tanielle |
| Credentials | Physical Therapist Assistant (PTA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447351564 | NPPES |
| Wisconsin | MEDICAID | 40459000 |
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