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General NPI Number Information
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NPI Number | 1982739207
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Entity Type | Individual
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Provider Name | TANYA MARIE BARBOSA ATC
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 77 MASSACHUSETTS AVE MIT BOX 397404
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4301
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Country | US
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Telephone | 617-253-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 39 RIDGECREST TER APT 10
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City | WEST ROXBURY
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State | MA
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Zip | 02132-5254
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Country | US
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Telephone | 401-996-3317
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1717
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License Number State | MA
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