Individual
TATSIANA SIANIUTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11880 BUSTLETON AVE STE 201, PHILADELPHIA, PA 19116-2538
(267) 357-5247
Mailing address
11880 BUSTLETON AVE STE 201, PHILADELPHIA, PA 19116-2538
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
20120677543-0615
NV
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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