Provider Demographics
NPI:1639304504
Name:MAGNEY, TANYA TRICIA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:TRICIA
Last Name:MAGNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 SE 17TH STREET CSWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2960
Mailing Address - Country:US
Mailing Address - Phone:954-240-0530
Mailing Address - Fax:
Practice Address - Street 1:570 OCEAN DR APT 501
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1953
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA46329OtherLICENSED MASSAGE THERAPIST