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General NPI Number Information
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NPI Number | 1073090304
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Entity Type | Individual
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Provider Name | TAMARA JEAN MATHIES CMT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 80 37TH AVE S
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3720
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Country | US
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Telephone | 320-291-1592
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Fax |
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Provider Business Mailing Address
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Address Line | 815 10TH AVE N APT 306
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City | SARTELL
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State | MN
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Zip | 56377-2293
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Country | US
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Telephone | 320-291-1592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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