Healthcare Provider Details

I. General information

NPI: 1184443756
Provider Name (Legal Business Name): TAMERA WALLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 E FIR AVE
FRESNO CA
93720-3862
US

IV. Provider business mailing address

PO BOX 25042
FRESNO CA
93729-5042
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-1703
  • Fax: 559-322-1793
Mailing address:
  • Phone: 559-322-1703
  • Fax: 559-322-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: