Provider Demographics
NPI:1568550275
Name:NEYLAND-GOINES, TAMMY RAQUEL (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RAQUEL
Last Name:NEYLAND-GOINES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:TAMMY
Other - Middle Name:RAQUEL
Other - Last Name:GOINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4212 JERI LYNN CT
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2109
Mailing Address - Country:US
Mailing Address - Phone:678-755-0110
Mailing Address - Fax:
Practice Address - Street 1:4535 FLAT SHOALS PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5039
Practice Address - Country:US
Practice Address - Phone:678-755-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist