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General NPI Number Information
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NPI Number | 1225753379
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Entity Type | Individual
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Provider Name | ANGELINE TENNE
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Gender | Female
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 3215 ROCK CREEK VILLA DR STE I
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City | QUINTON
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State | VA
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Zip | 23141-1656
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Country | US
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Telephone | 804-548-5758
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Fax |
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Provider Business Mailing Address
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Address Line | 5561 SCOTSVIEW DR
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City | PROVIDENCE FORGE
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State | VA
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Zip | 23140-4470
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Country | US
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Telephone | 804-548-5758
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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 | 0019017147
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License Number State | VA
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