Provider Demographics
NPI:1023185345
Name:LETTIERI, TAMAH C (P T)
Entity Type:Individual
Prefix:MS
First Name:TAMAH
Middle Name:C
Last Name:LETTIERI
Suffix:
Gender:F
Credentials:P T
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:LETTIERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:P T
Mailing Address - Street 1:2500 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-6050
Mailing Address - Country:US
Mailing Address - Phone:561-302-0686
Mailing Address - Fax:954-360-0308
Practice Address - Street 1:2500 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-6050
Practice Address - Country:US
Practice Address - Phone:561-302-0686
Practice Address - Fax:954-360-0308
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7650Medicare ID - Type UnspecifiedPHYSICAL THERAPY