Provider Demographics
NPI:1407049695
Name:KIRKLAND, TENA R (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:TENA
Middle Name:R
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MISS
Other - First Name:TENA
Other - Middle Name:R
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-1005
Mailing Address - Country:US
Mailing Address - Phone:912-375-2009
Mailing Address - Fax:912-379-0081
Practice Address - Street 1:147 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6466
Practice Address - Country:US
Practice Address - Phone:912-375-2009
Practice Address - Fax:912-379-0081
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist