Healthcare Provider Details

I. General information

NPI: 1790106243
Provider Name (Legal Business Name): TAMMIE HOLLINGSWORTH-PUCKETT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMIE HOLLINGSWORTH LMT

II. Dates (important events)

Enumeration Date: 01/01/2014
Last Update Date: 01/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9813 CODA PL NE
ALBUQUERQUE NM
87111-3544
US

IV. Provider business mailing address

9813 CODA PL NE
ALBUQUERQUE NM
87111-3544
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-1344
  • Fax:
Mailing address:
  • Phone: 505-803-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7507
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: