Provider Demographics
NPI:1407179658
Name:TABBERRAH, MARIA CONCEPCION REYES (RPT)
Entity type:Individual
Prefix:MS
First Name:MARIA CONCEPCION
Middle Name:REYES
Last Name:TABBERRAH
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Gender:F
Credentials:RPT
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Mailing Address - Street 1:2001 CONNECTICUT ST.
Mailing Address - Street 2:APARTMENT D3
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-782-2917
Mailing Address - Fax:417-782-7038
Practice Address - Street 1:214 W. 5TH ST.
Practice Address - Street 2:GMM PRO-CARE PROVIDERS, INC.
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:417-782-7038
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070017498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist