Provider Demographics
NPI:1154885556
Name:FORREST, TANNER DEAN (ATC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:DEAN
Last Name:FORREST
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-2072
Mailing Address - Country:US
Mailing Address - Phone:620-704-0888
Mailing Address - Fax:
Practice Address - Street 1:2108 HORTON ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-3141
Practice Address - Country:US
Practice Address - Phone:620-704-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer