Provider Demographics
NPI:1467229260
Name:TIUSECO, MARCO LORENZO TAMONDONG (PT)
Entity Type:Individual
Prefix:
First Name:MARCO LORENZO
Middle Name:TAMONDONG
Last Name:TIUSECO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 LA DUE AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-3242
Mailing Address - Country:US
Mailing Address - Phone:726-209-9661
Mailing Address - Fax:
Practice Address - Street 1:1335 6TH ST
Practice Address - Street 2:
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-3201
Practice Address - Country:US
Practice Address - Phone:719-657-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist