Provider Demographics
NPI:1457526931
Name:WEBBER, TAMMY GAIL
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:GAIL
Last Name:WEBBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 US ROUTE 60 E STE 160
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2070
Mailing Address - Country:US
Mailing Address - Phone:304-638-5618
Mailing Address - Fax:
Practice Address - Street 1:5505 US ROUTE 60 E STE 160
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2070
Practice Address - Country:US
Practice Address - Phone:304-638-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999-0409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist