Provider Demographics
NPI:1790106243
Name:HOLLINGSWORTH-PUCKETT, TAMMIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:
Last Name:HOLLINGSWORTH-PUCKETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:
Other - Last Name:HOLLINGSWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:9813 CODA PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3544
Mailing Address - Country:US
Mailing Address - Phone:505-803-1344
Mailing Address - Fax:
Practice Address - Street 1:9813 CODA PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3544
Practice Address - Country:US
Practice Address - Phone:505-803-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-01
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7507225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist