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Individual
TENNILLE E. MARIE
Active
Individual
TENNILLE E. MARIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT013492L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206036
HEALTH AMER/HEALTH ASSUR.
PA
01
—
7694334
AETNA
PA
01
—
SI602780
HIGHMARK BLUE SHIELD
PA
Enumeration date
10/06/2006
Last updated
07/08/2007
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