Provider Demographics
NPI:1841579208
Name:MAMBA, TSABILE (PT)
Entity Type:Individual
Prefix:
First Name:TSABILE
Middle Name:
Last Name:MAMBA
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 1:14409 GREENVIEW DR
Mailing Address - Street 2:STE 102
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3293
Mailing Address - Country:US
Mailing Address - Phone:301-498-8100
Mailing Address - Fax:301-498-0009
Practice Address - Street 1:14409 GREENVIEW DR
Practice Address - Street 2:STE 102
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3293
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:301-498-0009
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist