Provider Demographics
NPI:1073090304
Name:MATHIES, TAMARA JEAN (CMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:JEAN
Last Name:MATHIES
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 10TH AVE N APT 306
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2293
Mailing Address - Country:US
Mailing Address - Phone:320-291-1592
Mailing Address - Fax:
Practice Address - Street 1:80 37TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3720
Practice Address - Country:US
Practice Address - Phone:320-291-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist