Provider Demographics
NPI:1235673658
Name:BLADES-BARRETT, TONYA (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BLADES-BARRETT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22267 SUMMIT VUE LN
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7248
Mailing Address - Country:US
Mailing Address - Phone:818-297-6268
Mailing Address - Fax:747-226-1444
Practice Address - Street 1:22267 SUMMIT VUE LN
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7248
Practice Address - Country:US
Practice Address - Phone:818-297-6268
Practice Address - Fax:747-226-1444
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist