MEDICARE: TANYA TIMEKA CORBETT LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT014770	GA

General Provider Information

NPI Number	:	1710706056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA TIMEKA CORBETT LMT

Provider Business Mailing Address
First Line	:	5600 SPALDING DR UNIT 920442
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30010-4702
Country	:	US
Telephone Number	:	678-350-6325
Fax Number	:

Provider Business Practice Location Address
First Line	:	8737 DUNWOODY PL STE 2
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2985
Country	:	US
Telephone Number	:	678-350-6325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2024
Last Update Date	:	10/04/2024

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Directions to “ TANYA TIMEKA CORBETT LMT” Practice Location

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