Provider Demographics
NPI:1114794930
Name:BEARD, TAMMY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MERRIMONT DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-6802
Mailing Address - Country:US
Mailing Address - Phone:803-719-3950
Mailing Address - Fax:
Practice Address - Street 1:207 MERRIMONT DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-6802
Practice Address - Country:US
Practice Address - Phone:803-719-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist