Provider Demographics
NPI:1841592201
Name:MAY, TAMPTHA L (MT)
Entity Type:Individual
Prefix:
First Name:TAMPTHA
Middle Name:L
Last Name:MAY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-3374
Mailing Address - Country:US
Mailing Address - Phone:903-495-2613
Mailing Address - Fax:
Practice Address - Street 1:3394 N US HIGHWAY 259
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5086
Practice Address - Country:US
Practice Address - Phone:903-663-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT102359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist