Provider Demographics
NPI:1043539224
Name:LEARY, TONYA DEON (LMT,NCMT)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:DEON
Last Name:LEARY
Suffix:
Gender:F
Credentials:LMT,NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 HAMPTON HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5174
Mailing Address - Country:US
Mailing Address - Phone:770-851-8217
Mailing Address - Fax:
Practice Address - Street 1:230 COLLINS INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5445
Practice Address - Country:US
Practice Address - Phone:770-280-2167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist