Provider Demographics
NPI:1255054466
Name:THOMAS, TARA SUZAHN (LMT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:SUZAHN
Last Name:THOMAS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2550
Mailing Address - Country:US
Mailing Address - Phone:757-323-2712
Mailing Address - Fax:
Practice Address - Street 1:3149 SHORE DR STE A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1110
Practice Address - Country:US
Practice Address - Phone:757-323-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist