Provider Demographics
NPI:1396190211
Name:TINNEY, DWIGHT (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:
Last Name:TINNEY
Suffix:
Gender:M
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 1:105 SAINT MARY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4017
Mailing Address - Country:US
Mailing Address - Phone:903-456-5712
Mailing Address - Fax:
Practice Address - Street 1:105 SAINT MARY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4017
Practice Address - Country:US
Practice Address - Phone:903-456-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175L00000XOther Service ProvidersHomeopath
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer