Provider Demographics
NPI:1063177863
Name:JOE, TAMMY (PT, DPT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:JOE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 CLEAR CREEK DR APT 307
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-1680
Mailing Address - Country:US
Mailing Address - Phone:952-486-3393
Mailing Address - Fax:
Practice Address - Street 1:2695 NORTHPARK DR STE 102
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3177
Practice Address - Country:US
Practice Address - Phone:303-926-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist