Provider Demographics
NPI:1083994362
Name:STORM, TINA (LMT CLT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:LMT CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MEDITATION LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-2741
Mailing Address - Country:US
Mailing Address - Phone:978-413-6743
Mailing Address - Fax:
Practice Address - Street 1:12 MEDITATION LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2741
Practice Address - Country:US
Practice Address - Phone:978-413-6743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist