Provider Demographics
NPI:1134233018
Name:FELEGY, TAMARA LU (MPT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LU
Last Name:FELEGY
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 1:545 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6841
Mailing Address - Country:US
Mailing Address - Phone:651-636-0903
Mailing Address - Fax:
Practice Address - Street 1:1405 SILVER LAKE RD NW
Practice Address - Street 2:SUITE 8
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-9301
Practice Address - Country:US
Practice Address - Phone:651-206-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN99F92FEOtherBCBS INDIVIDUAL NUMBER
MN99F90PROtherBCBS PROVIDER NUMBER
MN99F92FEOtherBCBS INDIVIDUAL NUMBER