Provider Demographics
NPI:1144374273
Name:ROBERTS, TAMMY JEAN (RPT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 PAMELA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3784
Mailing Address - Country:US
Mailing Address - Phone:316-722-7798
Mailing Address - Fax:
Practice Address - Street 1:750 N SOCORA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3793
Practice Address - Country:US
Practice Address - Phone:316-462-7732
Practice Address - Fax:316-462-2276
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist