Healthcare Provider Details

I. General information

NPI: 1225697303
Provider Name (Legal Business Name): TONYA TENNELLE BRIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5853 YORK RD
BALTIMORE MD
21212-3613
US

IV. Provider business mailing address

7829 TILGHMAN ST
FULTON MD
20759-2580
US

V. Phone/Fax

Practice location:
  • Phone: 410-365-5918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: