MEDICARE: TIANA LONG 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	MA86678	FL

General Provider Information

NPI Number	:	1730787953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA LONG LMT

Provider Business Mailing Address
First Line	:	1623 E 4TH AVE UNIT 106
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-5109
Country	:	US
Telephone Number	:	863-812-5781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 E 4TH AVE UNIT 106
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-5109
Country	:	US
Telephone Number	:	863-812-5781
Fax Number	:

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

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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