Provider Demographics
NPI:1598934556
Name:MELLON, TAMMY (RPT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MELLON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2959
Mailing Address - Country:US
Mailing Address - Phone:423-566-2250
Mailing Address - Fax:423-566-5896
Practice Address - Street 1:2301 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2959
Practice Address - Country:US
Practice Address - Phone:423-566-2250
Practice Address - Fax:423-566-5896
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT859208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPT859OtherPHYSICAL THERAPY LICENSE