Provider Demographics
NPI:1669286001
Name:GRANT, TAMARA J (LMT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1105 GRINDSTONE RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-9605
Mailing Address - Country:US
Mailing Address - Phone:817-709-4186
Mailing Address - Fax:
Practice Address - Street 1:161 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6211
Practice Address - Country:US
Practice Address - Phone:817-709-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist