Provider Demographics
NPI:1982817649
Name:KELLEY, TAMMY RENA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RENA
Last Name:KELLEY
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 1:4320 W EL PRADO BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8498
Mailing Address - Country:US
Mailing Address - Phone:813-839-1808
Mailing Address - Fax:
Practice Address - Street 1:4320 W EL PRADO BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8498
Practice Address - Country:US
Practice Address - Phone:813-839-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2023OtherBLUE CROSS BLUE SHIELD