Provider Demographics
NPI:1003386897
Name:RADOV, TAMI LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TAMI
Middle Name:LYNN
Last Name:RADOV
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5882
Mailing Address - Country:US
Mailing Address - Phone:301-646-9026
Mailing Address - Fax:
Practice Address - Street 1:22 JAYSTONE CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5882
Practice Address - Country:US
Practice Address - Phone:301-646-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist