=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144179607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONYA TAYLOR LMBT, MLD-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 E MARKET ST STE 3
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27589-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-377-9088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4030 WAKE FOREST RD STE 349
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27609-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-377-9088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 23044
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------