Provider Demographics
NPI:1558985028
Name:WINDLAND, TISHA (LMT)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:WINDLAND
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 1:210 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170-1097
Mailing Address - Country:US
Mailing Address - Phone:304-699-1419
Mailing Address - Fax:304-586-6424
Practice Address - Street 1:210 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:WV
Practice Address - Zip Code:26170-1097
Practice Address - Country:US
Practice Address - Phone:304-699-1419
Practice Address - Fax:304-586-6424
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2017-3540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2017-3540OtherLMT LICENSE