Provider Demographics
NPI:1427579523
Name:CARLISLE, TAMARA (MA, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-3512
Mailing Address - Country:US
Mailing Address - Phone:281-860-3822
Mailing Address - Fax:
Practice Address - Street 1:828 SHELDON RD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-3512
Practice Address - Country:US
Practice Address - Phone:281-860-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer