Provider Demographics
NPI:1376847822
Name:LUPIEN, TAMMY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:LUPIEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 SABLE TRACE HOLW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7653
Mailing Address - Country:US
Mailing Address - Phone:678-574-8003
Mailing Address - Fax:
Practice Address - Street 1:805 SABLE TRACE HOLW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7653
Practice Address - Country:US
Practice Address - Phone:678-574-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000619225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant