Provider Demographics
NPI:1184479024
Name:DEMARTINI, TESSA TANIA (LMT)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:TANIA
Last Name:DEMARTINI
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 1:862 E EIGHTH ST STE F
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2727
Mailing Address - Country:US
Mailing Address - Phone:406-868-1165
Mailing Address - Fax:
Practice Address - Street 1:862 E EIGHTH ST STE F
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2727
Practice Address - Country:US
Practice Address - Phone:406-868-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014560225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist