Healthcare Provider Details

I. General information

NPI: 1801453071
Provider Name (Legal Business Name): TAMIKO S NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 W BELL RD # F-208
GLENDALE AZ
85308-3917
US

IV. Provider business mailing address

5115 W BELL RD # F-208
GLENDALE AZ
85308-3917
US

V. Phone/Fax

Practice location:
  • Phone: 800-856-6054
  • Fax:
Mailing address:
  • Phone: 602-354-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19647
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: