Provider Demographics
NPI:1225753379
Name:TENNE, ANGELINE
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:TENNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 SCOTSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-4470
Mailing Address - Country:US
Mailing Address - Phone:804-548-5758
Mailing Address - Fax:
Practice Address - Street 1:3215 ROCK CREEK VILLA DR STE I
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1656
Practice Address - Country:US
Practice Address - Phone:804-548-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist