Provider Demographics
NPI:1275911679
Name:PROTHRO-JONES, TINA (PT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PROTHRO-JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 GRENNAN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5415
Mailing Address - Country:US
Mailing Address - Phone:971-278-8973
Mailing Address - Fax:
Practice Address - Street 1:20823 STEVENS CREEK BLVD
Practice Address - Street 2:#200
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2108
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist