Provider Demographics
NPI:1932666989
Name:HARRISON, TAMMY (LMT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HARRISON
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 1:20425 N 7TH ST APT 3034
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6018
Mailing Address - Country:US
Mailing Address - Phone:480-266-2630
Mailing Address - Fax:
Practice Address - Street 1:4716 E THUNDERBIRD RD STE 151
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5541
Practice Address - Country:US
Practice Address - Phone:480-766-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-10390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist