Provider Demographics
NPI:1871551044
Name:ROLE, TAMMY DENISE (MPT)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:DENISE
Last Name:ROLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-3207
Mailing Address - Country:US
Mailing Address - Phone:509-892-1495
Mailing Address - Fax:
Practice Address - Street 1:209 N DAVIS LN
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3207
Practice Address - Country:US
Practice Address - Phone:509-892-1495
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist