Provider Demographics
NPI:1558125831
Name:CHILDERS, TINA LANGLEY (PERSONAL TRAINER)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LANGLEY
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 HAYNES RD NE
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-5481
Mailing Address - Country:US
Mailing Address - Phone:256-550-1146
Mailing Address - Fax:
Practice Address - Street 1:1938 N BRINDLEE MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-5433
Practice Address - Country:US
Practice Address - Phone:256-550-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach