Provider Demographics
NPI:1710465620
Name:TARNOWSKI, AMY K (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:TARNOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 KENNEBUCK CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1330
Mailing Address - Country:US
Mailing Address - Phone:919-741-8092
Mailing Address - Fax:
Practice Address - Street 1:THE LODGE AT WAKE FOREST
Practice Address - Street 2:1151 SOUTH MAIN STREET
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-939-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP8496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist