Provider Demographics
NPI:1336129360
Name:TABINGO, ANTHONY RENEL II (MPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RENEL
Last Name:TABINGO
Suffix:II
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 S DARTMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4104
Mailing Address - Country:US
Mailing Address - Phone:909-831-9923
Mailing Address - Fax:951-924-2335
Practice Address - Street 1:13373 PERRIS BLVD
Practice Address - Street 2:SUITE C-202-B
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4206
Practice Address - Country:US
Practice Address - Phone:951-924-6332
Practice Address - Fax:951-924-2335
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist