Individual
COREY MICHAEL TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4326 N 35TH AVE APT 1042, PHOENIX, AZ 85017-3867
(623) 418-4657
Mailing address
4326 N 35TH AVE APT 1042, PHOENIX, AZ 85017-3867
(623) 418-4657
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
—
—
225700000X
Massage Therapist
Primary
28168
AZ
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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