Provider Demographics
NPI:1255597852
Name:TAMMANY, JUSTIN E (DPT)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:TAMMANY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S PECOS ST.
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834
Mailing Address - Country:US
Mailing Address - Phone:217-324-8780
Mailing Address - Fax:217-324-8622
Practice Address - Street 1:310 S PECOS ST.
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834
Practice Address - Country:US
Practice Address - Phone:325-625-2135
Practice Address - Fax:217-324-8622
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009342A225100000X
IL070016808225100000X
TX1227953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist