Individual
TAMMY BACCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, DOR
Contact information
Practice address
1221 BROAD ST, FUQUAY VARINA, NC 27526-3602
(919) 424-5080
Mailing address
103 BERMUDA GREEN DR, DURHAM, NC 27703-2921
(980) 267-2559
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3943
NC
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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