Provider Demographics
NPI:1538436993
Name:FLEMING, TAWNYA TRAYLOR (LMT)
Entity type:Individual
Prefix:
First Name:TAWNYA
Middle Name:TRAYLOR
Last Name:FLEMING
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 1:913 ALLIEGOOD CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4659
Mailing Address - Country:US
Mailing Address - Phone:850-294-2404
Mailing Address - Fax:
Practice Address - Street 1:325 JOHN KNOX RD BLDG T
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4113
Practice Address - Country:US
Practice Address - Phone:850-294-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3041OtherBCBS