Individual
MR. OMAR TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1435 W BROWN ST, APT 3, MILWAUKEE, WI 53205-1227
(414) 418-8608
Mailing address
1435 W BROWN ST, APT 3, MILWAUKEE, WI 53205-1227
(414) 418-8608
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1198-19
WI
Other
Enumeration date
09/22/2008
Last updated
09/22/2008
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