Provider Demographics
NPI:1942647474
Name:PERRY, TENNINA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:TENNINA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11236 CHERRY HILL RD
Mailing Address - Street 2:# T1
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3840
Mailing Address - Country:US
Mailing Address - Phone:240-491-1151
Mailing Address - Fax:240-965-7793
Practice Address - Street 1:6846 RACE TRACK RD
Practice Address - Street 2:SUITE #104
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3011
Practice Address - Country:US
Practice Address - Phone:240-491-1151
Practice Address - Fax:240-965-7793
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist