Provider Demographics
NPI:1912280868
Name:TADIAMAN, EMERALD T (RPT)
Entity Type:Individual
Prefix:MISS
First Name:EMERALD
Middle Name:T
Last Name:TADIAMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43251 HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4969
Mailing Address - Country:US
Mailing Address - Phone:661-946-6499
Mailing Address - Fax:
Practice Address - Street 1:1115 W AVENUE M14
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1407
Practice Address - Country:US
Practice Address - Phone:661-265-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist