Provider Demographics
NPI:1205663853
Name:PARKER, TANISHA (LMT)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:PARKER
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 1:333 SW 5TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2509
Mailing Address - Country:US
Mailing Address - Phone:541-471-0397
Mailing Address - Fax:541-471-6459
Practice Address - Street 1:333 SW 5TH ST STE B
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2509
Practice Address - Country:US
Practice Address - Phone:541-471-0397
Practice Address - Fax:541-471-6459
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist