Provider Demographics
NPI:1558495077
Name:TENDRIH, LEONARDO (PT)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:TENDRIH
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 1:505 DOS CERROS CORTE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1962
Mailing Address - Country:US
Mailing Address - Phone:917-238-2041
Mailing Address - Fax:805-904-6217
Practice Address - Street 1:505 DOS CERROS CORTE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1962
Practice Address - Country:US
Practice Address - Phone:917-238-2041
Practice Address - Fax:805-904-6217
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027120225100000X
CA36774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ4R02Q49W1Medicare PIN
CAGY433AMedicare PIN