Provider Demographics
NPI:1710706056
Name:CORBETT, TANYA TIMEKA (LMT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:TIMEKA
Last Name:CORBETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5600 SPALDING DR UNIT 920442
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-4702
Mailing Address - Country:US
Mailing Address - Phone:678-350-6325
Mailing Address - Fax:
Practice Address - Street 1:8737 DUNWOODY PL STE 2
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2985
Practice Address - Country:US
Practice Address - Phone:678-350-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAMT014770225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist