Provider Demographics
NPI:1063751063
Name:TANNER, VALARIE NICOLE (RKT)
Entity type:Individual
Prefix:MRS
First Name:VALARIE
Middle Name:NICOLE
Last Name:TANNER
Suffix:
Gender:F
Credentials:RKT
Other - Prefix:MS
Other - First Name:VALARIE
Other - Middle Name:NICOLE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RKT
Mailing Address - Street 1:3701 LOOP RD
Mailing Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5015
Mailing Address - Country:US
Mailing Address - Phone:205-554-2822
Mailing Address - Fax:
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-554-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1770226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist