Provider Demographics
NPI:1225281082
Name:STOCKWELL, TAMMY LYN (LMT)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYN
Last Name:STOCKWELL
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 1:229 SPRING HAVEN LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-9407
Mailing Address - Country:US
Mailing Address - Phone:352-238-4122
Mailing Address - Fax:
Practice Address - Street 1:229 SPRING HAVEN LOOP
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-9407
Practice Address - Country:US
Practice Address - Phone:352-238-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA41454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist