Provider Demographics
NPI:1588747372
Name:QUISENBERRY, TAMMY (PT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:QUISENBERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1956
Mailing Address - Country:US
Mailing Address - Phone:682-205-3340
Mailing Address - Fax:682-205-3342
Practice Address - Street 1:300 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1956
Practice Address - Country:US
Practice Address - Phone:682-205-3340
Practice Address - Fax:682-205-3342
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10494682251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86530TOtherBLUE CROSS BLUE SHIELD
TX86530TOtherBLUE CROSS BLUE SHIELD