Provider Demographics
NPI:1437775624
Name:PIATT, TAMMY MARIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MARIE
Last Name:PIATT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 INDEPENDENCE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5025
Mailing Address - Country:US
Mailing Address - Phone:573-208-8342
Mailing Address - Fax:
Practice Address - Street 1:2917 INDEPENDENCE ST STE 400
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5025
Practice Address - Country:US
Practice Address - Phone:573-208-8342
Practice Address - Fax:573-651-8686
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004025273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist