Provider Demographics
NPI:1437830064
Name:ADAMS, TANDRA (PT)
Entity Type:Individual
Prefix:
First Name:TANDRA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 MORRISON RD STE 310
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5318
Mailing Address - Country:US
Mailing Address - Phone:614-755-2347
Mailing Address - Fax:614-755-2348
Practice Address - Street 1:630 MORRISON RD STE 310
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5318
Practice Address - Country:US
Practice Address - Phone:614-755-2347
Practice Address - Fax:614-755-2348
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT009228208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation