Provider Demographics
NPI:1073890083
Name:MARCIN, TAMALA ROSE (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:TAMALA
Middle Name:ROSE
Last Name:MARCIN
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 1:716 MORNING STAR CT
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1779
Mailing Address - Country:US
Mailing Address - Phone:317-430-6283
Mailing Address - Fax:843-236-9544
Practice Address - Street 1:716 MORNING STAR CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-1779
Practice Address - Country:US
Practice Address - Phone:317-430-6283
Practice Address - Fax:843-236-9544
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist