Provider Demographics
NPI:1689221574
Name:KARR, TANYA (CMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:KARR
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 N HIGHWAY 49-88 STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2013
Mailing Address - Country:US
Mailing Address - Phone:209-257-9854
Mailing Address - Fax:
Practice Address - Street 1:847 N HIGHWAY 49-88 STE 4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2013
Practice Address - Country:US
Practice Address - Phone:209-257-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CA76829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator