Provider Demographics
NPI:1891939831
Name:BERTRAND, TAMARA FOUGHT (LMT)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:FOUGHT
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 TULLY ST
Mailing Address - Street 2:UNIT 7056
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5730
Mailing Address - Country:US
Mailing Address - Phone:850-797-9439
Mailing Address - Fax:
Practice Address - Street 1:151 MARY ESTER BLVD
Practice Address - Street 2:SUITE 309B
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:32569
Practice Address - Country:US
Practice Address - Phone:850-797-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021856225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist