Provider Demographics
NPI:1780896522
Name:SCIMECA, TAMMY M (PT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:SCIMECA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17413 HIGHWAY 40 E
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-2637
Mailing Address - Country:US
Mailing Address - Phone:985-974-5464
Mailing Address - Fax:
Practice Address - Street 1:17413 HIGHWAY 40 E
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-2637
Practice Address - Country:US
Practice Address - Phone:985-974-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1302473Medicaid
LA01630OtherPT LICENSE