Provider Demographics
NPI:1629119433
Name:MURACCO, TABITHA CHARLES (MSPT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:CHARLES
Last Name:MURACCO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:KAY
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3202 ELAND DOWNE
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3600
Practice Address - Country:US
Practice Address - Phone:610-489-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013629L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist