Provider Demographics
NPI:1689115149
Name:JOE, TAMMY S
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:JOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 LITTLE DIPPER AVE
Mailing Address - Street 2:#A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4124
Mailing Address - Country:US
Mailing Address - Phone:907-717-6303
Mailing Address - Fax:
Practice Address - Street 1:1535 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1035
Practice Address - Country:US
Practice Address - Phone:907-717-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK116529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist