Provider Demographics
NPI:1386727964
Name:TANAKA, KAREN LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:TANAKA
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 1:2993 S PEORIA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5704
Mailing Address - Country:US
Mailing Address - Phone:720-747-8444
Mailing Address - Fax:720-747-4712
Practice Address - Street 1:2993 S PEORIA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5704
Practice Address - Country:US
Practice Address - Phone:720-747-8444
Practice Address - Fax:720-747-4712
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
457208Medicare ID - Type Unspecified