Provider Demographics
NPI:1154457562
Name:KLASSEN, TAMMA CAIN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMA
Middle Name:CAIN
Last Name:KLASSEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:TAMMA
Other - Middle Name:HUSTON
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:3701 NW CARY PARKWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-388-0111
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:3701 NW CARY PARKWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513
Practice Address - Country:US
Practice Address - Phone:919-388-0111
Practice Address - Fax:919-388-8668
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068CWOtherBCBS OF NC
NC802636OtherACN
NC2500915Medicare UPIN