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General NPI Number Information
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NPI Number | 1538340435
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Entity Type | Individual
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Provider Name | ROBIN LYNN TYSON LMT
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Gender | Female
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 1215 RIDGEWOOD DR STE A
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2690
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Country | US
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Telephone | 419-352-0142
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Fax |
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Provider Business Mailing Address
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Address Line | 135 EDGEWOOD DR APT 2
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City | PERRYSBURG
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State | OH
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Zip | 43551-6613
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Country | US
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Telephone | 419-467-1155
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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 | 8492
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License Number State | OH
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