Provider Demographics
NPI:1720135064
Name:KING, TAMMY ELAINE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ELAINE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ELAINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14504 BRAMBIE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2636
Mailing Address - Country:US
Mailing Address - Phone:813-962-6991
Mailing Address - Fax:813-962-6991
Practice Address - Street 1:14504 BRAMBIE CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2636
Practice Address - Country:US
Practice Address - Phone:813-962-6991
Practice Address - Fax:813-962-6991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist