Provider Demographics
NPI:1598456428
Name:KOCHER, TANIA GEOCONDA (LMT)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:GEOCONDA
Last Name:KOCHER
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 1:1920 E EDGEWOOD DR APT I2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3405
Mailing Address - Country:US
Mailing Address - Phone:863-308-1453
Mailing Address - Fax:
Practice Address - Street 1:1920 E EDGEWOOD DR APT I2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3405
Practice Address - Country:US
Practice Address - Phone:863-308-1453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist