Individual
TANNER SPADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1211 S DOUGLAS HWY STE 100, GILLETTE, WY 82716-4982
(307) 670-9191
(307) 670-9193
Mailing address
1211 S DOUGLAS HWY STE 100, GILLETTE, WY 82716-4982
(307) 670-9191
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1715
WY
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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