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General NPI Number Information
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NPI Number | 1265734750
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Entity Type | Individual
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Provider Name | JOYCE LANELLE TYSON LICENSED MASSAGE THE
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Gender | Female
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 223 NORTH CENTRAL AVENUE
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-387-7111
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Fax | 229-387-7111
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Provider Business Mailing Address
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Address Line | 2111 FERRY LAKE RD
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-386-2534
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Fax | 229-386-2534
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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 | MT001391
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License Number State | GA
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