Healthcare Provider Details

I. General information

NPI: 1972237592
Provider Name (Legal Business Name): TIA SHERNA VINSON RMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 WOODMONT AVE APT C
BALITMORE MD
21239
US

IV. Provider business mailing address

PO BOX 66209
BALTIMORE MD
21239
US

V. Phone/Fax

Practice location:
  • Phone: 410-209-0507
  • Fax:
Mailing address:
  • Phone: 410-209-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberR03002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: