MEDICARE: TYANA WASHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT133656	TX

General Provider Information

NPI Number	:	1770182255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYANA WASHINGTON

Provider Business Mailing Address
First Line	:	1018 PORT NECHES DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5935
Country	:	US
Telephone Number	:	157-385-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 PORT NECHES DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5935
Country	:	US
Telephone Number	:	573-855-6292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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Directions to “ TYANA WASHINGTON ” Practice Location

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