Provider Demographics
NPI:1043388663
Name:TICHENOR, CAROL JO (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JO
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:JO
Other - Last Name:TICHENOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:11478 CULL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-9525
Mailing Address - Country:US
Mailing Address - Phone:510-675-4259
Mailing Address - Fax:510-675-3241
Practice Address - Street 1:3555 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1507
Practice Address - Country:US
Practice Address - Phone:510-675-4259
Practice Address - Fax:510-675-3241
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT778752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic