MEDICARE: TOMMIE A DEYAMPERT LPTA

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	225200000X	Physical Therapy Assistant	2306000099	VA

General Provider Information

NPI Number	:	1942461041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMIE A DEYAMPERT LPTA

Provider Business Mailing Address
First Line	:	4403 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3241
Country	:	US
Telephone Number	:	804-231-0231
Fax Number	:

Provider Business Practice Location Address
First Line	:	4403 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3241
Country	:	US
Telephone Number	:	804-231-0231
Fax Number	:

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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