Provider Demographics
NPI:1265734750
Name:TYSON, JOYCE LANELLE (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:LANELLE
Last Name:TYSON
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2111 FERRY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-386-2534
Mailing Address - Fax:229-386-2534
Practice Address - Street 1:223 NORTH CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-387-7111
Practice Address - Fax:229-387-7111
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist