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General NPI Number Information
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NPI Number | 1689115149
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Entity Type | Individual
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Provider Name | TAMMY S JOE
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Gender | Female
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 1535 E TUDOR RD
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City | ANCHORAGE
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State | AK
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Zip | 99507-1035
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Country | US
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Telephone | 907-717-8984
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Fax |
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Provider Business Mailing Address
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Address Line | 7921 LITTLE DIPPER AVE #A
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City | ANCHORAGE
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State | AK
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Zip | 99504-4124
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Country | US
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Telephone | 907-717-6303
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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 | 116529
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License Number State | AK
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