Provider Demographics
NPI:1013105824
Name:WADE, TAMMIE JEAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:JEAN
Last Name:WADE
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 1:135 W FRONT ST S
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:TN
Mailing Address - Zip Code:38330-1909
Mailing Address - Country:US
Mailing Address - Phone:731-692-9500
Mailing Address - Fax:
Practice Address - Street 1:135 W FRONT ST S
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:TN
Practice Address - Zip Code:38330-1909
Practice Address - Country:US
Practice Address - Phone:731-692-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist