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General NPI Number Information
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NPI Number | 1760713101
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Entity Type | Individual
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Provider Name | SEAN PATRICK TIERNEY LMT
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Gender | Male
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 2629 W 23RD ST E
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City | PANAMA CITY
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State | FL
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Zip | 32405-2311
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Country | US
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Telephone | 850-215-4884
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Fax |
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Provider Business Mailing Address
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Address Line | 319 FAN PALM PL
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408-7743
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Country | US
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Telephone | 850-319-1006
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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 | 57885
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License Number State | FL
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