Individual
TAMARA DZIADEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1106 HAZEL ST, PORT ANGELES, WA 98363-2302
(360) 417-9484
(360) 417-8826
Mailing address
1106 HAZEL ST, PORT ANGELES, WA 98363-2302
(360) 417-9484
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT00006788
WA
2251G0304X
Geriatric Physical Therapist
Primary
PT00006788
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7093230
—
WA
01
—
P00209911
PALMETTO GBA RR MEDICAREB
WA
Enumeration date
07/16/2005
Last updated
02/21/2015
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