Provider Demographics
NPI:1447757125
Name:TAM, ANTHONY G (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:TAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 BONITA RD STE B
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1700
Mailing Address - Country:US
Mailing Address - Phone:619-479-7473
Mailing Address - Fax:619-479-9376
Practice Address - Street 1:5030 BONITA RD STE B
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1700
Practice Address - Country:US
Practice Address - Phone:619-479-7473
Practice Address - Fax:619-479-9376
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports