Provider Demographics
NPI:1467972109
Name:BROOKS, TONYA LORRELL (LMT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LORRELL
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:LORRELL
Other - Last Name:BROOKS-TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:331 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1172
Mailing Address - Country:US
Mailing Address - Phone:781-856-6152
Mailing Address - Fax:857-578-2256
Practice Address - Street 1:331 PAGE ST STE 2
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1172
Practice Address - Country:US
Practice Address - Phone:781-886-6152
Practice Address - Fax:857-578-2256
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist