Provider Demographics
NPI:1225438328
Name:TIRABASSI, NATHAN CARMAN (DPM)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CARMAN
Last Name:TIRABASSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:P.O. BOX 355
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-922-4731
Mailing Address - Fax:585-922-2183
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:355
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-4731
Practice Address - Fax:585-922-2183
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer