Provider Demographics
NPI:1700221025
Name:DEYOUNG, TONYA RO (LMT)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:RO
Last Name:DEYOUNG
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 1:3312 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4612
Mailing Address - Country:US
Mailing Address - Phone:269-267-4887
Mailing Address - Fax:
Practice Address - Street 1:3608 S BURDICK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4838
Practice Address - Country:US
Practice Address - Phone:269-267-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000408174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist