Individual
TANYA STALLWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 JULIA ST, BERKELEY, CA 94703-2017
(510) 717-8591
Mailing address
1625 JULIA ST, BERKELEY, CA 94703-2017
(510) 717-8591
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
74538
CA
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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