Provider Demographics
NPI:1942433750
Name:COGGINS, TAMMY LYNN (LMT #LA4024-01)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:COGGINS
Suffix:
Gender:F
Credentials:LMT #LA4024-01
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3326
Mailing Address - Country:US
Mailing Address - Phone:318-469-1225
Mailing Address - Fax:318-868-3483
Practice Address - Street 1:297 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-3326
Practice Address - Country:US
Practice Address - Phone:318-469-1225
Practice Address - Fax:318-868-3483
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225700000X225700000X
LALMT #4024-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist