Provider Demographics
NPI:1679664429
Name:SMITH, TAMMY D (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5021 NW 34TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1191
Mailing Address - Country:US
Mailing Address - Phone:352-377-3322
Mailing Address - Fax:352-377-5200
Practice Address - Street 1:5021 NW 34TH ST STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1191
Practice Address - Country:US
Practice Address - Phone:352-377-3322
Practice Address - Fax:352-377-5200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist