Individual
ROBERT TANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC, MA
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
005221
KY
225100000X
Physical Therapist
Primary
05001580A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000272141
BLUE CROSS BLUE SHIELD
IN
05
—
200829440
—
IN
01
—
P00019865
MEDICARE RAILROAD
IN
Enumeration date
12/06/2005
Last updated
02/08/2011
Update your record
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