Provider Demographics
NPI:1447583851
Name:SERBIN, TINA JULLE (PTA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:JULLE
Last Name:SERBIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30506
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-0506
Mailing Address - Country:US
Mailing Address - Phone:330-219-7295
Mailing Address - Fax:
Practice Address - Street 1:32531 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 105-162
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1519
Practice Address - Country:US
Practice Address - Phone:480-488-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7642A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant