Provider Demographics
NPI:1447429485
Name:TENGRA, JOHN (OTR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TENGRA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9898 COLONNADE BLVD APT 11204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2277
Mailing Address - Country:US
Mailing Address - Phone:210-641-7911
Mailing Address - Fax:
Practice Address - Street 1:130 SPENCER LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2109
Practice Address - Country:US
Practice Address - Phone:210-733-9363
Practice Address - Fax:210-733-9383
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist