=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356549885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE P TAMONDONG PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 W ALAMEDA AVE STE 102
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91502-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-566-8443
-----------------------------------------------------
Fax | 818-566-8434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29235 BERNARDO WAY
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91354-1583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-440-3538
-----------------------------------------------------
Fax | 818-566-8434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 26341
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------