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NPI Code Detail

MEDICARE: MISS TAMMY GAIL BACKLUND PTA

MEDICARE: MISS TAMMY GAIL BACKLUND PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA3438NC

General Provider Information

NPI Number : 1881960599
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TAMMY GAIL BACKLUND PTA
Provider Business Mailing Address
First Line : 355 DAYTON DR
Second Line :
City : WAYNESVILLE
State : NC
Zip : 28786-6931
Country : US
Telephone Number : 423-915-6707
Fax Number :
Provider Business Practice Location Address
First Line : 75 FISHER LOOP
Second Line :
City : MAGGIE VALLEY
State : NC
Zip : 28751-5531
Country : US
Telephone Number : 828-946-4326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2012
Last Update Date : 03/27/2012

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