Provider Demographics
NPI:1912141847
Name:ROBERSON-GREEN, TAMMARA ELISE (PT)
Entity type:Individual
Prefix:MS
First Name:TAMMARA
Middle Name:ELISE
Last Name:ROBERSON-GREEN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17840 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4733
Mailing Address - Country:US
Mailing Address - Phone:708-217-2667
Mailing Address - Fax:
Practice Address - Street 1:1370 RING RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5428
Practice Address - Country:US
Practice Address - Phone:708-217-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist