Provider Demographics
NPI:1215498977
Name:CARSON, TONYA MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:MARIE
Last Name:CARSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 MANDARIN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8463
Mailing Address - Country:US
Mailing Address - Phone:407-235-8498
Mailing Address - Fax:
Practice Address - Street 1:5385 CONROY RD STE 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3719
Practice Address - Country:US
Practice Address - Phone:407-516-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist