Provider Demographics
NPI:1326414269
Name:SHOULDERS, TAMARA HOPPER (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:HOPPER
Last Name:SHOULDERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 S KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93523-2429
Mailing Address - Country:US
Mailing Address - Phone:520-417-4305
Mailing Address - Fax:
Practice Address - Street 1:755 S KNIGHT DR
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93523-2429
Practice Address - Country:US
Practice Address - Phone:520-417-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1265760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist