Provider Demographics
NPI:1699738997
Name:DEMAY, TAMI J (LPT)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:J
Last Name:DEMAY
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 E COLLEGE AVE STE B
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4623
Practice Address - Country:US
Practice Address - Phone:309-663-6777
Practice Address - Fax:309-663-6779
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002755E174400000X
IL070018837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA819711OtherFIRST PRIORITY HEALTH
PA20-2108080OtherTRICARE
PA267233OtherHEALTH AMERICA PROV #
PA1062692OtherAETNA
PAP00256578OtherMEDICARE RAILROAD
PA1014316410001Medicaid
PA001766902OtherBC/ BS/ NE PA IND PROV #
PAP00256578OtherMEDICARE RAILROAD