Individual
GERALD TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1101 GRACE ST, WICHITA FALLS, TX 76301-4414
(940) 720-5120
Mailing address
1219 DANBERRY ST, BURKBURNETT, TX 76354-3121
(940) 569-2619
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2054850
TX
Other
Enumeration date
10/05/2007
Last updated
10/05/2007
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