Provider Demographics
NPI:1770948309
Name:YEGGE, TANIA (LMT)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:YEGGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4224 S FEDERAL WAY
Mailing Address - Street 2:APT. V-106
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5577
Mailing Address - Country:US
Mailing Address - Phone:208-972-1910
Mailing Address - Fax:
Practice Address - Street 1:3050 N LAKEHARBOR LN # 164
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6906
Practice Address - Country:US
Practice Address - Phone:208-972-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121623225700000X
IDMAS-2721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist