Provider Demographics
NPI:1639907876
Name:MANGINI, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MANGINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 W CAMINO VIVAZ
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-5043
Mailing Address - Country:US
Mailing Address - Phone:602-402-9306
Mailing Address - Fax:
Practice Address - Street 1:11321 W BELL RD STE 43
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9363
Practice Address - Country:US
Practice Address - Phone:602-402-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-13445225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist