Provider Demographics
NPI:1477253649
Name:BAIN, TAMMY (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BAIN
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 1:4124 QUEBEC AVE N STE 207B
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1240
Mailing Address - Country:US
Mailing Address - Phone:612-581-9273
Mailing Address - Fax:
Practice Address - Street 1:4124 QUEBEC AVE N STE 207B
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1240
Practice Address - Country:US
Practice Address - Phone:612-581-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist