Provider Demographics
NPI:1043839806
Name:STANDAGE, TAMRA HOLMES (DPT)
Entity Type:Individual
Prefix:DR
First Name:TAMRA
Middle Name:HOLMES
Last Name:STANDAGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S NATIONAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3634
Mailing Address - Country:US
Mailing Address - Phone:417-269-8355
Mailing Address - Fax:
Practice Address - Street 1:2900 S NATIONAL AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3634
Practice Address - Country:US
Practice Address - Phone:417-269-8355
Practice Address - Fax:417-269-8854
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist