Provider Demographics
NPI:1720384001
Name:TINDOC, LEO ERNANI TOBIAS (DPT)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:ERNANI TOBIAS
Last Name:TINDOC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PARACLETE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-9282
Mailing Address - Country:US
Mailing Address - Phone:910-222-1200
Mailing Address - Fax:910-565-2073
Practice Address - Street 1:142 PARACLETE DR STE 301
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-9282
Practice Address - Country:US
Practice Address - Phone:910-222-1200
Practice Address - Fax:910-565-2073
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist