Provider Demographics
NPI:1427833888
Name:TABACSKO, CAMERON ELISHA (DPT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ELISHA
Last Name:TABACSKO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 POMEROY AVE APT 2301
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-1770
Mailing Address - Country:US
Mailing Address - Phone:878-379-6080
Mailing Address - Fax:
Practice Address - Street 1:84 GLASTONBURY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4468
Practice Address - Country:US
Practice Address - Phone:860-652-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist