=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467211748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONITA LIGAS RN, LMT, CMLDT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2024
-----------------------------------------------------
Last Update Date | 03/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 231 3RD ST
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45750-8009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-481-2350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 COVENTRY RD
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45750-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-481-2350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 2022-3970
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | 33.020431
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WM1400X
-----------------------------------------------------
Taxonomy Name | Nurse Massage Therapist (NMT)
-----------------------------------------------------
License Number | RN.357345
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------