Provider Demographics
NPI:1154993137
Name:BURGOS, TANIA (LMT)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:BURGOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RMT
Mailing Address - Street 1:6422 CHELL RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3901
Mailing Address - Country:US
Mailing Address - Phone:631-953-1162
Mailing Address - Fax:
Practice Address - Street 1:6422 CHELL RD UNIT B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3901
Practice Address - Country:US
Practice Address - Phone:631-953-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR02452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist