Healthcare Provider Details

I. General information

NPI: 1174347439
Provider Name (Legal Business Name): TAMMY TOMICH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19351 W ASHLEY DR
BUCKEYE AZ
85326-9604
US

IV. Provider business mailing address

19351 W ASHLEY DR
BUCKEYE AZ
85326-9604
US

V. Phone/Fax

Practice location:
  • Phone: 262-498-3448
  • Fax:
Mailing address:
  • Phone: 262-498-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-24960
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: