Provider Demographics
NPI:1538376975
Name:IGLEHART, TAMMY K (PT, ATC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:IGLEHART
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:K
Other - Last Name:SCHWARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:4991 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-9651
Mailing Address - Country:US
Mailing Address - Phone:701-337-6488
Mailing Address - Fax:
Practice Address - Street 1:275 2ND ST SW
Practice Address - Street 2:STE B
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540
Practice Address - Country:US
Practice Address - Phone:970-231-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3638225100000X
ND2008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABY421ZMedicare UPIN