Individual
TINA HOUSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1210 HOLDEN DR, AUGUSTA, GA 30904-3831
(706) 750-4561
Mailing address
1210 HOLDEN DR, AUGUSTA, GA 30904-3831
(706) 750-4561
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MT011736
GA
225700000X
Massage Therapist
Primary
MY011736
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MT011736
—
GA
Enumeration date
04/23/2020
Last updated
04/23/2020
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