Provider Demographics
NPI:1932233848
Name:LAGASSE, TAMMY LOUISE (PTA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LOUISE
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 A1A S
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6773
Mailing Address - Country:US
Mailing Address - Phone:904-471-2999
Mailing Address - Fax:
Practice Address - Street 1:4075 A1A S
Practice Address - Street 2:SUITE 105
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6773
Practice Address - Country:US
Practice Address - Phone:904-471-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA15835225200000X
FLMA39295225700000X
FLMM16788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist