Provider Demographics
NPI:1477009132
Name:ROEHL, TANIA (LAC)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:ROEHL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2712
Mailing Address - Country:US
Mailing Address - Phone:703-472-9103
Mailing Address - Fax:
Practice Address - Street 1:3140 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2712
Practice Address - Country:US
Practice Address - Phone:703-472-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist