Provider Demographics
NPI:1467775585
Name:THOMAS, TAMARA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28811 S TAMIAMI TRL
Mailing Address - Street 2:UNIT 13-14
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-3201
Mailing Address - Country:US
Mailing Address - Phone:239-248-1988
Mailing Address - Fax:239-498-9885
Practice Address - Street 1:28811 S TAMIAMI TRL
Practice Address - Street 2:UNIT 13-14
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-3201
Practice Address - Country:US
Practice Address - Phone:239-248-1988
Practice Address - Fax:239-498-9885
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA18526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist