Provider Demographics
NPI:1427144799
Name:TULACRO, TAMMY SUE (LPT/LAT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:SUE
Last Name:TULACRO
Suffix:
Gender:F
Credentials:LPT/LAT
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:SUE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT/LAT
Mailing Address - Street 1:109 FOX HILL CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5736
Mailing Address - Country:US
Mailing Address - Phone:618-655-9831
Mailing Address - Fax:
Practice Address - Street 1:1105 E HARRIS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2221
Practice Address - Country:US
Practice Address - Phone:618-664-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0332010OtherBCBS
IL734380OtherHEALTHLINK PPO
IL0332010OtherBCBS
IL213144Medicare ID - Type UnspecifiedMEDICARE GROUP