Provider Demographics
NPI:1225170087
Name:TININENKO, NATASHA (DPT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:TININENKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2310
Mailing Address - Country:US
Mailing Address - Phone:760-591-7750
Mailing Address - Fax:760-294-9813
Practice Address - Street 1:3703 CAMINO DEL RIO S
Practice Address - Street 2:STE. 100A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4031
Practice Address - Country:US
Practice Address - Phone:619-269-2336
Practice Address - Fax:619-269-7608
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist