Provider Demographics
NPI:1528664927
Name:DUNCAN, TANYA NICOLE (ATC, LAT, ITAT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:NICOLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:ATC, LAT, ITAT
Other - Prefix:
Other - First Name:NYCOLE
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC, LAT, ITAT
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-5000
Mailing Address - Country:US
Mailing Address - Phone:304-876-5348
Mailing Address - Fax:304-876-3267
Practice Address - Street 1:301 N. KING STREET
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-5000
Practice Address - Country:US
Practice Address - Phone:304-876-5348
Practice Address - Fax:304-876-3267
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0205020692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer