Provider Demographics
NPI:1821569781
Name:TUMULAK, CLAIREDALE (PT)
Entity Type:Individual
Prefix:
First Name:CLAIREDALE
Middle Name:
Last Name:TUMULAK
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 1:109 HIGHWAY 70 N
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-4001
Mailing Address - Country:US
Mailing Address - Phone:423-272-3099
Mailing Address - Fax:
Practice Address - Street 1:109 HIGHWAY 70 N
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-4001
Practice Address - Country:US
Practice Address - Phone:423-272-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9729208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation