Provider Demographics
NPI:1255376505
Name:HASQUE, TAMMY L (LMT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:HASQUE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1790 POMELO DRIVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293
Mailing Address - Country:US
Mailing Address - Phone:941-493-8596
Mailing Address - Fax:941-493-8596
Practice Address - Street 1:115 TAMIAMI TRAIL
Practice Address - Street 2:SUITE 9
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275
Practice Address - Country:US
Practice Address - Phone:941-232-0184
Practice Address - Fax:941-493-8596
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0010670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C7212Medicare UPIN