Healthcare Provider Details

I. General information

NPI: 1700221025
Provider Name (Legal Business Name): TONYA RO DEYOUNG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 S BURDICK ST
KALAMAZOO MI
49001-4838
US

IV. Provider business mailing address

3312 WOOD ST
KALAMAZOO MI
49008-4612
US

V. Phone/Fax

Practice location:
  • Phone: 269-267-4887
  • Fax:
Mailing address:
  • Phone: 269-267-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7501000408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: