Provider Demographics
NPI:1689368631
Name:HIRCOCK, TANYA LYNAE (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNAE
Last Name:HIRCOCK
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 1:6340 YANK CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3884
Mailing Address - Country:US
Mailing Address - Phone:720-301-1395
Mailing Address - Fax:
Practice Address - Street 1:6340 YANK CT UNIT A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3884
Practice Address - Country:US
Practice Address - Phone:720-301-1395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0001727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist