Healthcare Provider Details

I. General information

NPI: 1629629266
Provider Name (Legal Business Name): TAMMY M MARGOSIAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GOLD STAR BLVD
WORCESTER MA
01606-2812
US

IV. Provider business mailing address

50 GOLD STAR BLVD
WORCESTER MA
01606-2812
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-9510
  • Fax: 508-853-1907
Mailing address:
  • Phone: 508-856-9510
  • Fax: 508-853-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17419
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: