Provider Demographics
NPI:1770949547
Name:TACCHETTI, ROBIN (PT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:TACCHETTI
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 1:1320 HENNESSY TER
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20860-1201
Mailing Address - Country:US
Mailing Address - Phone:301-460-7388
Mailing Address - Fax:
Practice Address - Street 1:1320 HENNESSY TER
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1201
Practice Address - Country:US
Practice Address - Phone:301-460-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist