Provider Demographics
NPI:1932565157
Name:ROE, TAMBRA (PT)
Entity Type:Individual
Prefix:
First Name:TAMBRA
Middle Name:
Last Name:ROE
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 1:2114 TERRIWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1129
Mailing Address - Country:US
Mailing Address - Phone:502-314-5831
Mailing Address - Fax:502-429-8356
Practice Address - Street 1:2114 TERRIWOOD CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1129
Practice Address - Country:US
Practice Address - Phone:502-314-5831
Practice Address - Fax:502-429-8356
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY001307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist