Provider Demographics
NPI:1780817726
Name:MCEWEN, TAMMY L (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12909 N 56TH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1275
Mailing Address - Country:US
Mailing Address - Phone:813-989-0861
Mailing Address - Fax:813-464-7645
Practice Address - Street 1:12909 N 56TH ST
Practice Address - Street 2:STE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1275
Practice Address - Country:US
Practice Address - Phone:813-989-0861
Practice Address - Fax:813-464-7645
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38002225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist