NPI 1770744328

Tony Hardaway, LMTNCTMB

Practitioner Massage Therapist Caruthersville, MO

Practice location

Address: 105 W 12th St 105 W. 12th Street, Caruthersville, MO 63830-1817
Phone: (573) 333-1690
Mailing address: 105 W 12th St P.O. Box 727, Caruthersville, MO 63830-1817

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 2007000188 (MO)

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Registry record

NPI: 1770744328
Entity type: Individual
Sex (as registered): Male
NPI issued: 17 Jun 2008
Record last updated: 17 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.