Provider Demographics
NPI:1568742807
Name:PICHARDO, TINA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:PICHARDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:910 REGENCY SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-1800
Mailing Address - Country:US
Mailing Address - Phone:772-564-9292
Mailing Address - Fax:772-564-9293
Practice Address - Street 1:910 REGENCY SQ
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-1800
Practice Address - Country:US
Practice Address - Phone:772-564-9292
Practice Address - Fax:772-564-9293
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist