Provider Demographics
NPI:1144569898
Name:MCCALLUM, TAMAR ELIZABETH (MS, ATC, VATL)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:ELIZABETH
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:MS, ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 SPRINGWOOD MEADOW LN
Mailing Address - Street 2:APT #102
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2764
Mailing Address - Country:US
Mailing Address - Phone:703-924-7579
Mailing Address - Fax:703-924-7436
Practice Address - Street 1:7630 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3821
Practice Address - Country:US
Practice Address - Phone:703-924-7579
Practice Address - Fax:703-924-7436
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer