Provider Demographics
NPI:1487826251
Name:TANKHELSON, SIMION (LMT)
Entity Type:Individual
Prefix:
First Name:SIMION
Middle Name:
Last Name:TANKHELSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 SW 75TH DR
Mailing Address - Street 2:APT 324
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8595
Mailing Address - Country:US
Mailing Address - Phone:352-505-3559
Mailing Address - Fax:
Practice Address - Street 1:2441 NW 43RD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7469
Practice Address - Country:US
Practice Address - Phone:352-378-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist