Provider Demographics
NPI:1154630432
Name:GABRIEL, TAMARA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N.TUCSON BLVD.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4757
Mailing Address - Country:US
Mailing Address - Phone:520-323-5059
Mailing Address - Fax:520-323-5567
Practice Address - Street 1:48 N.TUCSON BLVD.
Practice Address - Street 2:SUITE 106
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4757
Practice Address - Country:US
Practice Address - Phone:520-323-5059
Practice Address - Fax:520-323-5567
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist