Provider Demographics
NPI:1619352838
Name:VEAD, TAMARA MICHELLE BIVINS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MICHELLE BIVINS
Last Name:VEAD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:MICHELLE
Other - Last Name:BIVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1244 N FLINT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-5239
Mailing Address - Country:US
Mailing Address - Phone:704-240-3933
Mailing Address - Fax:704-240-3500
Practice Address - Street 1:1244 NORTH FLINT ST.
Practice Address - Street 2:SUITE 5
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-240-3933
Practice Address - Fax:704-240-3500
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist