MEDICARE: TAMARA DOWIE-DAVENPORT RPT

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	PT19244	CA

General Provider Information

NPI Number	:	1689633554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA DOWIE-DAVENPORT RPT

Provider Business Mailing Address
First Line	:	1000 FREMONT AVE
Second Line	:	STE. 108
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-6093
Country	:	US
Telephone Number	:	650-947-8500
Fax Number	:	650-947-8501

Provider Business Practice Location Address
First Line	:	1000 FREMONT AVE
Second Line	:	STE. 108
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-6093
Country	:	US
Telephone Number	:	650-947-8500
Fax Number	:	650-947-8501

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/08/2007

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