Provider Demographics
NPI:1306271796
Name:BRANTNER, TATUM N (DPT)
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:N
Last Name:BRANTNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WAYLAND SMITH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-2677
Mailing Address - Country:US
Mailing Address - Phone:724-437-8200
Mailing Address - Fax:724-437-6673
Practice Address - Street 1:150 WAYLAND SMITH DR
Practice Address - Street 2:SUITE A
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2677
Practice Address - Country:US
Practice Address - Phone:724-437-8200
Practice Address - Fax:724-437-6673
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT021778OtherLICENSE