Provider Demographics
NPI:1588627046
Name:CAMPER, TABITHA BRASHER (DPT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:BRASHER
Last Name:CAMPER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329-4222
Mailing Address - Country:US
Mailing Address - Phone:731-257-1555
Mailing Address - Fax:844-892-9378
Practice Address - Street 1:494 TENNESSEE AVE S
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-4615
Practice Address - Country:US
Practice Address - Phone:731-257-1555
Practice Address - Fax:844-892-9378
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare ID - Type UnspecifiedGROUP