Provider Demographics
NPI:1629248018
Name:ROECKER, TAMMY J (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:ROECKER
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 1:10364 W. COUNTRY CLUB TRAIL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383
Mailing Address - Country:US
Mailing Address - Phone:602-697-6463
Mailing Address - Fax:
Practice Address - Street 1:8279 W LAKE PLEASANT PKWY SUITE 106
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5125
Practice Address - Country:US
Practice Address - Phone:602-697-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCERTIFIED DOULA174400000X
AZCERTIFIED CBE174H00000X
AZMT-04599P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator