Provider Demographics
NPI:1194158832
Name:DELANO, TANYA A (CMT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:A
Last Name:DELANO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CENTRAL PARK BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4942
Mailing Address - Country:US
Mailing Address - Phone:540-842-5845
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:STE 211
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:540-842-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist