Provider Demographics
NPI:1881960599
Name:BACKLUND, TAMMY GAIL (PTA)
Entity type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:GAIL
Last Name:BACKLUND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 DAYTON DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6931
Mailing Address - Country:US
Mailing Address - Phone:423-915-6707
Mailing Address - Fax:
Practice Address - Street 1:75 FISHER LOOP
Practice Address - Street 2:
Practice Address - City:MAGGIE VALLEY
Practice Address - State:NC
Practice Address - Zip Code:28751-5531
Practice Address - Country:US
Practice Address - Phone:828-946-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3438225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant