Provider Demographics
NPI:1558195057
Name:MORELAND, TARAMETHIA (LMT)
Entity type:Individual
Prefix:
First Name:TARAMETHIA
Middle Name:
Last Name:MORELAND
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 1:101 BELGIAN CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3524
Mailing Address - Country:US
Mailing Address - Phone:470-502-3764
Mailing Address - Fax:
Practice Address - Street 1:1435 N EXPRESSWAY STE 103
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1700
Practice Address - Country:US
Practice Address - Phone:770-584-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014864225700000X, 225700000X
172M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist