Provider Demographics
NPI:1033829841
Name:TAMBERINO, MADISON BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOKE
Last Name:TAMBERINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:BROOKE
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:
Practice Address - Street 1:251 LEWIS LN STE 104
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3752
Practice Address - Country:US
Practice Address - Phone:410-939-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30312225100000X
PAPT030567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist