MEDICARE: TISSUE ISSUE INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT004305	OTHER	GA	ALL

General Provider Information

NPI Number	:	1841917382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TISSUE ISSUE INC

Provider Business Mailing Address
First Line	:	24 GLENDALE AVE STE F
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-0245
Country	:	US
Telephone Number	:	850-725-3061
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 GLENDALE AVE STE F
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-0245
Country	:	US
Telephone Number	:	850-725-3061
Fax Number	:	912-705-3061

Authorized Official
Title or Position	:	CEO
Name	:	TONI HALE-TINNER
Credential	:
Telephone Number	:	850-725-3061

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	03/26/2024

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Directions to “TISSUE ISSUE INC ” Practice Location

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