Provider Demographics
NPI:1346508546
Name:ISHERWOOD, TAMI R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:R
Last Name:ISHERWOOD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:TAMI
Other - Middle Name:RENEE
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:10901 BRIGHTON BAY BLVD NE APT 8204
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3457
Mailing Address - Country:US
Mailing Address - Phone:585-746-0522
Mailing Address - Fax:
Practice Address - Street 1:10901 BRIGHTON BAY BLVD NE APT 8204
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3457
Practice Address - Country:US
Practice Address - Phone:585-746-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist