Provider Demographics
NPI:1427303486
Name:TABAMO, WILBUR B (RPT)
Entity type:Individual
Prefix:MR
First Name:WILBUR
Middle Name:B
Last Name:TABAMO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16089 POPPYSEED CIR
Mailing Address - Street 2:UNIT 2008
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6314
Mailing Address - Country:US
Mailing Address - Phone:561-496-7993
Mailing Address - Fax:561-496-0589
Practice Address - Street 1:4926 HULL ST
Practice Address - Street 2:APT 2W
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3129
Practice Address - Country:US
Practice Address - Phone:312-459-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.018855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist