Provider Demographics
NPI:1790441616
Name:SINN, TAMMY JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:SINN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARISSA
Mailing Address - State:IL
Mailing Address - Zip Code:62257-1029
Mailing Address - Country:US
Mailing Address - Phone:618-394-6859
Mailing Address - Fax:
Practice Address - Street 1:726 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-1026
Practice Address - Country:US
Practice Address - Phone:618-394-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160000311225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant