Provider Demographics
NPI:1639449820
Name:HUSTED, TINA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:L
Last Name:HUSTED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4383
Mailing Address - Country:US
Mailing Address - Phone:614-306-7036
Mailing Address - Fax:614-850-1478
Practice Address - Street 1:4821 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9496
Practice Address - Country:US
Practice Address - Phone:614-850-1476
Practice Address - Fax:614-850-1478
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic