Provider Demographics
NPI:1740459015
Name:TAMBI, ROBERTSON (PTA)
Entity type:Individual
Prefix:MR
First Name:ROBERTSON
Middle Name:
Last Name:TAMBI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3203
Mailing Address - Country:US
Mailing Address - Phone:617-889-3400
Mailing Address - Fax:617-889-3455
Practice Address - Street 1:32 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3203
Practice Address - Country:US
Practice Address - Phone:617-889-3400
Practice Address - Fax:617-889-3455
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69062Medicare Oscar/Certification