MEDICARE: TAMMY J ROECKER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	CERTIFIED DOULA	AZ
2	174H00000X	Health Educator	CERTIFIED CBE	AZ
3	225700000X	Massage Therapist	MT-04599P	AZ

General Provider Information

NPI Number	:	1629248018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY J ROECKER LMT

Provider Business Mailing Address
First Line	:	10364 W. COUNTRY CLUB TRAIL
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383
Country	:	US
Telephone Number	:	602-697-6463
Fax Number	:

Provider Business Practice Location Address
First Line	:	8279 W LAKE PLEASANT PKWY SUITE 106
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-5125
Country	:	US
Telephone Number	:	602-697-6463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	06/26/2023

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