Provider Demographics
NPI:1841608353
Name:TORRES, TAMIKA MICHELLE (PTA)
Entity Type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:MICHELLE
Last Name:TORRES
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 1:2208 OLEANDER DR APT 5
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6201
Mailing Address - Country:US
Mailing Address - Phone:912-977-9397
Mailing Address - Fax:
Practice Address - Street 1:703 LITTLE JOHN DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-6320
Practice Address - Country:US
Practice Address - Phone:912-977-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6541225200000X
GA003365225200000X
FL24681225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant