Provider Demographics
NPI:1396065892
Name:EASTERDAY, TAMERA E (PT)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:E
Last Name:EASTERDAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20241 W VALLEY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8746
Mailing Address - Country:US
Mailing Address - Phone:661-822-0811
Mailing Address - Fax:661-822-0905
Practice Address - Street 1:20241 W VALLEY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8746
Practice Address - Country:US
Practice Address - Phone:661-822-0811
Practice Address - Fax:661-822-0905
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist