Provider Demographics
NPI:1982210225
Name:CROY, TABITHA FAY (LMT)
Entity Type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:FAY
Last Name:CROY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:TABITHA
Other - Middle Name:FAY
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 S GEORGE MASON DR APT 10
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3479
Mailing Address - Country:US
Mailing Address - Phone:571-408-5379
Mailing Address - Fax:
Practice Address - Street 1:1525 S GEORGE MASON DR APT 10
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3479
Practice Address - Country:US
Practice Address - Phone:571-408-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015937225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist