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General NPI Number Information
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NPI Number | 1114425501
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Entity Type | Individual
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Provider Name | AMY TANKERSLEY
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Gender | Female
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 108 E BROADWAY AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-5740
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Country | US
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Telephone | 865-238-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 404 HUDSON ST
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City | MARYVILLE
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State | TN
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Zip | 37801-4613
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Country | US
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Telephone | 865-238-4224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 17334
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT10893
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License Number State | TN
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