Provider Demographics
NPI:1437652732
Name:TOURVILLE, TONYA (CMT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:TOURVILLE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-7701
Mailing Address - Country:US
Mailing Address - Phone:218-380-4110
Mailing Address - Fax:
Practice Address - Street 1:123 UNION ST S
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1542
Practice Address - Country:US
Practice Address - Phone:218-380-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN82-417-9776OtherFEDERAL TAX ID