Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1076 | NE |
N | 225200000X | Physical Therapy Assistant | PTA 06459 | OH |
NPI | 1013284827 |
---|---|
Provider Name | Mr. Raymond Michael Tamburro |
First Address | Lincoln, NE 68505-1786 |
Second Address | Lincoln, NE 68505-1786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2011 |
Last Update Date | 22/11/2011 |