Provider Demographics
NPI:1558841312
Name:TIHEN, TINA MARIE (PHYSICAL THERAPIST A)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:MARIE
Last Name:TIHEN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:TIHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 32ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3506 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1654
Practice Address - Country:US
Practice Address - Phone:262-653-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI981-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant