Provider Demographics
NPI:1760158356
Name:TOMINACK, VERIOSKA JAATSY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VERIOSKA
Middle Name:JAATSY
Last Name:TOMINACK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:VERIOSKA
Other - Middle Name:JAATSY
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:273 PENINSULA FARM RD STE C
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1012
Mailing Address - Country:US
Mailing Address - Phone:410-975-5343
Mailing Address - Fax:
Practice Address - Street 1:273 PENINSULA FARM RD STE C
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1012
Practice Address - Country:US
Practice Address - Phone:410-975-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5417225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant