Provider Demographics
NPI:1336165638
Name:WALLS, TAMMY L (PT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:WALLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5244
Mailing Address - Fax:740-446-5448
Practice Address - Street 1:98 STATE ST
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8163
Practice Address - Country:US
Practice Address - Phone:740-886-9403
Practice Address - Fax:740-446-5153
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH004951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000217253OtherANTHEM BCBS
650019657OtherRR MEDICARE
WV0156676000Medicaid
001714133OtherMOUNTAIN STATE BCBS
OH000000204435OtherOH MEDICAID UNISON
OH2226415Medicaid
OH2226415OtherMOLINA MEDICAID
WV0156676000Medicaid