Provider Demographics
NPI:1225089238
Name:MONDRY, TAMMY ELIZABETH (DPT, MSRS, CLT-LANA)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ELIZABETH
Last Name:MONDRY
Suffix:
Gender:F
Credentials:DPT, MSRS, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PASEO PACIFICA
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3644
Mailing Address - Country:US
Mailing Address - Phone:760-622-8686
Mailing Address - Fax:760-946-6308
Practice Address - Street 1:171 CALLE MAGDALENA STE 102
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3745
Practice Address - Country:US
Practice Address - Phone:760-644-8558
Practice Address - Fax:760-946-6308
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM44782251X0800X
CA20026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8TAB21OtherBCBS
TX8TAB21OtherBCBS
CAPT20026AMedicare PIN