Provider Demographics
NPI:1770135766
Name:REGIS, TAMMY (LMT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:REGIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 TERRA CEIA BAY CIR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5948
Mailing Address - Country:US
Mailing Address - Phone:941-877-9901
Mailing Address - Fax:
Practice Address - Street 1:1607 TERRA CEIA BAY CIR
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5948
Practice Address - Country:US
Practice Address - Phone:941-877-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist