Provider Demographics
NPI:1477557858
Name:KLATT, TAMARA DAVIS (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:DAVIS
Last Name:KLATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:1506 S SUNSET AVE STE B
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4813
Practice Address - Country:US
Practice Address - Phone:806-385-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1114635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153402602Medicaid
TX134469100OtherFIRSTCARE
TX8T2017OtherBLUE CROSS BLUE SHIELD
TX153402603Medicaid
TXP00325313OtherMEDICARE RAILROAD
TX153402603Medicaid