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General NPI Number Information
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NPI Number | 1710391651
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Entity Type | Individual
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Provider Name | TANYA COLUCCI LMT, MS
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Gender | Female
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 1 PROMENADE ST SUITE 201
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City | BLUFFTON
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State | SC
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Zip | 29910-7037
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Country | US
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Telephone | 202-812-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 52 SUGAR MAPLE ST
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City | BLUFFTON
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State | SC
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Zip | 29910-7678
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Country | US
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Telephone | 202-812-4242
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MAS 8971
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License Number State | SC
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