Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1447757125 |
---|---|
Provider Name | Anthony G Tam |
First Address | Bonita, CA 91902-1700 |
Second Address | Bonita, CA 91902-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |