Provider Demographics
NPI:1104542364
Name:HALE-TINNER, TONI
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:HALE-TINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GLENDALE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0245
Mailing Address - Country:US
Mailing Address - Phone:850-725-3061
Mailing Address - Fax:912-705-3061
Practice Address - Street 1:24 GLENDALE AVE STE F
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0245
Practice Address - Country:US
Practice Address - Phone:850-725-3061
Practice Address - Fax:912-705-3061
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist