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NPI Code Detail

MEDICARE: TAMMY RENAE WORTHAM PTA

MEDICARE:   TAMMY RENAE WORTHAM  PTA
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
1225200000XPhysical Therapy Assistant2022374TX

General Provider Information

NPI Number : 1629343637
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY RENAE WORTHAM PTA
Provider Business Mailing Address
First Line : 216 NEWPORT
Second Line :
City : VAN ALSTYNE
State : TX
Zip : 75495-2792
Country : US
Telephone Number : 903-327-3723
Fax Number :
Provider Business Practice Location Address
First Line : 601 E US HIGHWAY 69
Second Line :
City : DENISON
State : TX
Zip : 75021-6510
Country : US
Telephone Number : 903-465-2438
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2012
Last Update Date : 03/09/2012

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Directions to “ TAMMY RENAE WORTHAM PTA” Practice Location

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