Provider Demographics
NPI:1215760624
Name:ROSENBERGER, TAMARA LYNN (LMT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5441
Mailing Address - Country:US
Mailing Address - Phone:765-914-7988
Mailing Address - Fax:
Practice Address - Street 1:35 S 8TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5441
Practice Address - Country:US
Practice Address - Phone:765-914-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20902811225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist