Provider Demographics
NPI:1790974558
Name:MUSSARI, TAMMIE LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYNN
Last Name:MUSSARI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8073 WASHINGTON VILLAGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1847
Mailing Address - Country:US
Mailing Address - Phone:330-729-9448
Mailing Address - Fax:330-729-9450
Practice Address - Street 1:813 BOARDMAN POLAND RD
Practice Address - Street 2:STE 12B
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5129
Practice Address - Country:US
Practice Address - Phone:330-729-9448
Practice Address - Fax:330-729-9450
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018981225100000X
OHPT-018783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00898652OtherMEDICARE RAILROAD
WV4303951Medicare PIN
OHPT.013638Medicare PIN
PA121281Medicare Oscar/Certification