Provider Demographics
NPI:1962581355
Name:KEATTS, TAMMY LYNN (MPT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:KEATTS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 TIDEWATER COLONY DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2592
Mailing Address - Country:US
Mailing Address - Phone:410-266-8010
Mailing Address - Fax:443-782-2498
Practice Address - Street 1:2001 TIDEWATER COLONY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2592
Practice Address - Country:US
Practice Address - Phone:410-266-8010
Practice Address - Fax:443-782-2498
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD371442OtherMAMSI HEALTH CARE
MD407373800Medicaid
MD61023404OtherMARYLAND CAREFIRST BLUE
MDS4410006OtherCAREFIRST BLUE CHOICE
MDS4410006OtherCAREFIRST BLUE CHOICE
MD407373800Medicaid