Provider Demographics
NPI:1255720504
Name:MYHAN, TAMRA DEE (ATC/L)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:DEE
Last Name:MYHAN
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25907 WINTERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-5208
Mailing Address - Country:US
Mailing Address - Phone:256-679-8881
Mailing Address - Fax:
Practice Address - Street 1:925 FRANKLIN ST SE STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4307
Practice Address - Country:US
Practice Address - Phone:256-265-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer