Provider Demographics
NPI:1790016335
Name:RODELL, TAMMY A (MSPT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:A
Last Name:RODELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 COTTONWOOD PASS RD
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-9709
Mailing Address - Country:US
Mailing Address - Phone:970-331-2632
Mailing Address - Fax:970-524-2338
Practice Address - Street 1:260 COTTONWOOD PASS RD
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-9709
Practice Address - Country:US
Practice Address - Phone:970-331-2632
Practice Address - Fax:970-524-2338
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65462251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics