Provider Demographics
NPI:1760843296
Name:NORDBECK, TAMARA WATSON (BS, MPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:WATSON
Last Name:NORDBECK
Suffix:
Gender:F
Credentials:BS, MPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:27728 PERTH ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4667
Mailing Address - Country:US
Mailing Address - Phone:734-497-3739
Mailing Address - Fax:
Practice Address - Street 1:41850 W 11 MILE RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1857
Practice Address - Country:US
Practice Address - Phone:248-719-7002
Practice Address - Fax:734-468-0160
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist