Provider Demographics
NPI:1194852673
Name:TENNEY, HYRUM R (PT)
Entity type:Individual
Prefix:
First Name:HYRUM
Middle Name:R
Last Name:TENNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:TENNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:281 MOUNTAIN MYRTLE CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5491
Mailing Address - Country:US
Mailing Address - Phone:928-277-9003
Mailing Address - Fax:
Practice Address - Street 1:300 E GURLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3823
Practice Address - Country:US
Practice Address - Phone:928-445-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7612174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7612OtherSTATE LICENSE
AZAZ0461050OtherBLUE CROSS BLUE SHIELD