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General NPI Number Information
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NPI Number | 1043366321
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Entity Type | Individual
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Provider Name | MICHAEL DAVID TABASKO MSPT
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | PO BOX 932184
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City | ATLANTA
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State | GA
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Zip | 31193-3038
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Country | US
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Telephone | 806-771-7661
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Fax | 806-771-7661
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Provider Business Mailing Address
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Address Line | 2819 3RD ST
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City | BOULDER
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State | CO
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Zip | 80304-3038
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Country | US
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Telephone | 818-795-6140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P19867
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License Number State | NC
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