Tanner Spade, DPT, OCS, SCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-1715 Issued in WY

Practice address

109 W Hesse St
Buffalo, WY 82834-1501

Phone

(307) 621-0935

Fax

(844) 409-0424

NPI assigned

Jan 21, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Black Tooth Physiotherapy Performance, LLC

  • Physical Therapy Clinic/Center
  • Buffalo, WY
  • NPI 1306708557
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1659961845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W HESSE ST",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341501",
            "telephone_number": "307-621-0935",
            "fax_number": "844-409-0424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W HESSE ST",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341501",
            "telephone_number": "307-621-0935",
            "fax_number": "844-409-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPADE",
        "first_name": "TANNER",
        "credential": "DPT, OCS, SCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-21",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "PT-1715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mya Simondi
• Valerie Simondi
• Simply Chiropractic LLC
• Jennifer Lynn Skaggs, MS, LPC
• Chadwick Bardwell Sommers, PHARM D
• Spamony20 LLC (Corner Stone Pharmacy)
• State of Wyoming
• Dana Eaglefeather Stedman
• Rachel Leigh Stencel
• Adrianne M Stensaas, LPC

• Physical Therapist in Buffalo, WY
• Providers in Buffalo, WY by specialty
• Physical Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.