Provider Demographics
NPI:1609698554
Name:MONROE, TAWANA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:
Last Name:MONROE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 CLACTON AVE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3828
Mailing Address - Country:US
Mailing Address - Phone:240-550-5807
Mailing Address - Fax:
Practice Address - Street 1:9560 MARLBORO PIKE STE 101
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3770
Practice Address - Country:US
Practice Address - Phone:240-709-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03313225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist