Active NPI
Tammy K Wallen
- Physical Therapist
- Crystal River, FL
National Provider Identifier
1174845770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTA 22024
- Practice address
- 394 N Suncoast Blvd
Suite 40
Crystal River, FL 34429-5466 - Phone
- (352) 795-6225
- NPI assigned
- Feb 23, 2010
- Last updated
- Feb 23, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTA 22024 | FL | Primary |
Addresses
Primary practice location
394 N Suncoast Blvd
Suite 40
Crystal River, FL 34429-5466
Mailing address
8455 S Suncoast Blvd
Homosassa, FL 34446-5066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 22024 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TLC Rehab, LLC | Physical Therapist | Past | Accepting new patients |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Hernando, FL
- NPI 1548237118
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266883200000",
"number": "1174845770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8455 S SUNCOAST BLVD",
"city": "HOMOSASSA",
"state": "FL",
"postal_code": "344465066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "394 N SUNCOAST BLVD",
"address_2": "SUITE 40",
"city": "CRYSTAL RIVER",
"state": "FL",
"postal_code": "344295466",
"telephone_number": "352-795-6225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLEN",
"first_name": "TAMMY",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-23",
"last_updated": "2010-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PTA 22024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal River, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.