Provider Demographics
NPI:1225608623
Name:MCPHERSON, TANYA (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2539
Mailing Address - Country:US
Mailing Address - Phone:631-455-9347
Mailing Address - Fax:
Practice Address - Street 1:121 PULASKI RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2539
Practice Address - Country:US
Practice Address - Phone:631-478-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty