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NPI Code Detail

MEDICARE: ASHLEY GLENN TAMKE DPT

MEDICARE: ASHLEY GLENN TAMKE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT02291RI
2225100000XPhysical Therapist
3225100000XPhysical TherapistPT02401
4225100000XPhysical TherapistPT02291RI

General Provider Information

NPI Number : 1932421534
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY GLENN TAMKE DPT
Provider Business Mailing Address
First Line : 4 RICHMOND SQ STE 200
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-5117
Country : US
Telephone Number : 401-433-4172
Fax Number : 401-433-0612
Provider Business Practice Location Address
First Line : 1401 DOUGLAS AVE
Second Line :
City : NORTH PROVIDENCE
State : RI
Zip : 02904-4058
Country : US
Telephone Number : 401-726-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2010
Last Update Date : 11/18/2021

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Directions to “ ASHLEY GLENN TAMKE DPT” Practice Location

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