Provider Demographics
NPI:1295075935
Name:MOZINGO, TAMMY JANE (PT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:JANE
Last Name:MOZINGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 HASKEW LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37724-4636
Mailing Address - Country:US
Mailing Address - Phone:606-499-2593
Mailing Address - Fax:
Practice Address - Street 1:136 DAVIS LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3118
Practice Address - Country:US
Practice Address - Phone:423-562-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist