Provider Demographics
NPI:1790227643
Name:TAMARAY, JOHN MICHAEL LIM (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN MICHAEL
Middle Name:LIM
Last Name:TAMARAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:MICHAEL
Other - Last Name:TAMARAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1390 MARKET ST APT 2206
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5315
Mailing Address - Country:US
Mailing Address - Phone:828-273-2912
Mailing Address - Fax:
Practice Address - Street 1:212 RIVERBIRCH DRIVE
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732
Practice Address - Country:US
Practice Address - Phone:828-273-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292242225100000X
NCP7198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist