Provider Demographics
NPI:1114203734
Name:STOJADINOVIC, TAMARA ANTONIA (MA RYT)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:ANTONIA
Last Name:STOJADINOVIC
Suffix:
Gender:F
Credentials:MA RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 25 #246 X 20 Y 22
Mailing Address - Street 2:
Mailing Address - City:PROGRESO
Mailing Address - State:MEXICO
Mailing Address - Zip Code:97320
Mailing Address - Country:MX
Mailing Address - Phone:817-984-9642
Mailing Address - Fax:
Practice Address - Street 1:9504 WATERCRESS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-4906
Practice Address - Country:US
Practice Address - Phone:817-984-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist