Provider Demographics
NPI:1376980466
Name:TINGSON, CLEA SOL MINTANO (PT)
Entity Type:Individual
Prefix:MS
First Name:CLEA SOL
Middle Name:MINTANO
Last Name:TINGSON
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 1:12321 SEASHORE LN
Mailing Address - Street 2:APARTMENT 1-107
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0623
Mailing Address - Country:US
Mailing Address - Phone:904-314-7808
Mailing Address - Fax:
Practice Address - Street 1:12321 SEASHORE LN
Practice Address - Street 2:APARTMENT 1-107
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-0623
Practice Address - Country:US
Practice Address - Phone:904-314-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist