Provider Demographics
NPI:1710194659
Name:LAMBERT, TINA LEAH (LPTA)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:LEAH
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ATRIUM WAY APT 508
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6395
Mailing Address - Country:US
Mailing Address - Phone:757-652-4547
Mailing Address - Fax:
Practice Address - Street 1:2993 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3421
Practice Address - Country:US
Practice Address - Phone:803-939-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1999225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant