Active NPI
Tanise Fenelon, DPT
- Physical Therapist
- Winter Haven, FL
National Provider Identifier
1114243458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT23791
- Practice address
- 650 N Lake Howard Dr
Winter Haven, FL 33881-3162 - Phone
- (863) 293-4456
- NPI assigned
- Apr 12, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT23791 | FL | Primary |
Addresses
Primary practice location
650 N Lake Howard Dr
Winter Haven, FL 33881-3162
Mailing address
650 N Lake Howard Dr
Winter Haven, FL 33881-3162
Phone (863) 293-4456
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271030400000",
"number": "1114243458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 N LAKE HOWARD DR",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338813162",
"telephone_number": "863-293-4456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 N LAKE HOWARD DR",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338813162",
"telephone_number": "863-293-4456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENELON",
"first_name": "TANISE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-12",
"last_updated": "2010-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT23791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.