Basic Information
Provider Information | |||||||||
NPI: | 1124506910 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TAMMARO | ||||||||
FirstName: | MATTHEW | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 730 S BROAD ST | ||||||||
Address2: |   | ||||||||
City: | LANSDALE | ||||||||
State: | PA | ||||||||
PostalCode: | 194465211 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2676637767 | ||||||||
FaxNumber: | 2672228158 | ||||||||
Practice Location | |||||||||
Address1: | 708 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | HARLEYSVILLE | ||||||||
State: | PA | ||||||||
PostalCode: | 194381636 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2679329177 | ||||||||
FaxNumber: | 2679329180 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/02/2018 | ||||||||
LastUpdateDate: | 02/19/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/19/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT027076 | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.