Provider Demographics
NPI:1417737586
Name:BELTON, TAMMY RACHELE (LMT, BCTMB)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:RACHELE
Last Name:BELTON
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20310 AKIN CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8208
Mailing Address - Country:US
Mailing Address - Phone:612-801-1372
Mailing Address - Fax:
Practice Address - Street 1:19685 PILOT KNOB RD # 260
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-7238
Practice Address - Country:US
Practice Address - Phone:651-478-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist