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General NPI Number Information
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NPI Number | 1598635898
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Entity Type | Individual
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Provider Name | MR. JEFFREY BRENT TANNER
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Gender | Male
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 1492 S INDEPENDENCE BLVD STE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5252
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Country | US
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Telephone | 757-632-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 VALMIRE DR
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4730
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Country | US
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Telephone | 239-220-8840
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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 | 0019017830
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License Number State | VA
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