Provider Demographics
NPI:1518327295
Name:WITHROW, TINA (LMT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WITHROW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 HAMILTON EATON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-9718
Mailing Address - Country:US
Mailing Address - Phone:513-706-6600
Mailing Address - Fax:
Practice Address - Street 1:8106 BECKETT CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5015
Practice Address - Country:US
Practice Address - Phone:513-706-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-014250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist