Provider Demographics
NPI:1215615687
Name:TANGUAY, JAMIE L (PTA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:L
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 PALOU DR APT SUITE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4213
Mailing Address - Country:US
Mailing Address - Phone:415-531-4519
Mailing Address - Fax:
Practice Address - Street 1:785 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1987
Practice Address - Country:US
Practice Address - Phone:650-712-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA8316225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant