Healthcare Provider Details

I. General information

NPI: 1285286773
Provider Name (Legal Business Name): TATUM OVERBEEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATUM DAVIS

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 FESTIVAL PARK PLZ
CHESTER VA
23831-4449
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 804-930-8280
  • Fax: 804-930-8101
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213000
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: