Provider Demographics
NPI:1023830007
Name:FRATES, TAMMY A (LMT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:A
Last Name:FRATES
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 1:10 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1316
Mailing Address - Country:US
Mailing Address - Phone:508-552-1874
Mailing Address - Fax:
Practice Address - Street 1:10 E. LAKE ST.
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-733-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16586OtherMASSAGE THERAPIST LICENSE
RIHDR26831OtherCOSMETOLOGY LICENSE