Provider Demographics
NPI:1063890069
Name:BEAR, TABITHA L (DPT)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:L
Last Name:BEAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:L
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:340 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7971
Mailing Address - Country:US
Mailing Address - Phone:614-488-1816
Mailing Address - Fax:614-488-0390
Practice Address - Street 1:5500 N MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7687
Practice Address - Country:US
Practice Address - Phone:614-488-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020728225100000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist