Provider Demographics
NPI:1518222165
Name:HOUGLAND, TAMMARAH DAWN (PT)
Entity Type:Individual
Prefix:
First Name:TAMMARAH
Middle Name:DAWN
Last Name:HOUGLAND
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 1:719 CLINTON PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5245
Mailing Address - Country:US
Mailing Address - Phone:601-924-7828
Mailing Address - Fax:601-924-3979
Practice Address - Street 1:719 CLINTON PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5245
Practice Address - Country:US
Practice Address - Phone:601-924-7828
Practice Address - Fax:601-924-3979
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist