Provider Demographics
NPI:1902133077
Name:PRICE, TANNER JENNINGS (LMT)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:JENNINGS
Last Name:PRICE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9918 WILTSHIRE MANOR DR #204
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578
Mailing Address - Country:US
Mailing Address - Phone:813-624-8429
Mailing Address - Fax:
Practice Address - Street 1:8313 W HILLSBOROUGH AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3816
Practice Address - Country:US
Practice Address - Phone:813-886-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist