Provider Demographics
NPI:1629219084
Name:TISCHENKO, ANNA K (PT, PHD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:K
Last Name:TISCHENKO
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 SW 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1617
Mailing Address - Country:US
Mailing Address - Phone:305-775-9114
Mailing Address - Fax:
Practice Address - Street 1:7800 S RED RD STE 105
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5543
Practice Address - Country:US
Practice Address - Phone:305-779-2427
Practice Address - Fax:305-779-2437
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist