Provider Demographics
NPI:1225089238
Name:MONDRY, TAMMY ELIZABETH (DPT, MSRS, CLT-LANA)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ELIZABETH
Last Name:MONDRY
Suffix:
Gender:F
Credentials:DPT, MSRS, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1809 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4617
Mailing Address - Country:US
Mailing Address - Phone:575-437-1967
Mailing Address - Fax:575-437-3969
Practice Address - Street 1:2535 TRUXTUN RD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6160
Practice Address - Country:US
Practice Address - Phone:619-415-5817
Practice Address - Fax:619-934-9581
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM44782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8TAB21OtherBCBS
TX8TAB21OtherBCBS
CAPT20026AMedicare PIN