Provider Demographics
NPI:1063559177
Name:PARISE, TANIA M (PT)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:M
Last Name:PARISE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MEDICAL GROUP
Mailing Address - Street 2:45 PINE RD
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2080
Mailing Address - Country:US
Mailing Address - Phone:757-764-6963
Mailing Address - Fax:757-764-0975
Practice Address - Street 1:1ST MEDICAL GROUP
Practice Address - Street 2:45 PINE RD
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2080
Practice Address - Country:US
Practice Address - Phone:757-764-6963
Practice Address - Fax:757-764-0975
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21340171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider