Provider Demographics
NPI:1326007675
Name:HAACK, TAMMY JEAN (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JEAN
Last Name:HAACK
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GRANBY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2026
Mailing Address - Country:US
Mailing Address - Phone:860-844-8802
Mailing Address - Fax:
Practice Address - Street 1:350 SALMON BROOK ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-1842
Practice Address - Country:US
Practice Address - Phone:860-653-9888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004345225100000X
MA11746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist