Healthcare Provider Details

I. General information

NPI: 1912263732
Provider Name (Legal Business Name): TAMARA NEUBAUER-GOLD L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10638 WHEATLANDS WAY
HUNTLEY IL
60142-4010
US

IV. Provider business mailing address

10638 WHEATLANDS WAY
HUNTLEY IL
60142-4010
US

V. Phone/Fax

Practice location:
  • Phone: 773-771-1875
  • Fax:
Mailing address:
  • Phone: 773-771-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number227.004338
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number227.004338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: