MEDICARE: TAMARA DZIADEK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00006788	WA
2	2251G0304X	Geriatric Physical Therapist	PT00006788	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00209911	OTHER	WA	PALMETTO GBA RR MEDICAREB

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417956061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA DZIADEK PT

Provider Business Mailing Address
First Line	:	1106 HAZEL ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-2302
Country	:	US
Telephone Number	:	360-417-9484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 HAZEL ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-2302
Country	:	US
Telephone Number	:	360-417-9484
Fax Number	:	360-417-8826

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2005
Last Update Date	:	02/21/2015

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Directions to “ TAMARA DZIADEK PT” Practice Location

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