Provider Demographics
NPI:1225261761
Name:SPURLOCK, TAMMY (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SPURLOCK
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 1:814 CHADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4610
Mailing Address - Country:US
Mailing Address - Phone:813-368-6518
Mailing Address - Fax:
Practice Address - Street 1:814 CHADSWORTH AVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4610
Practice Address - Country:US
Practice Address - Phone:813-368-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist