Provider Demographics
NPI:1841755709
Name:TIZON, EDWIN JOSHUA JR (DPT)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:JOSHUA
Last Name:TIZON
Suffix:JR
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 1:1601 KETTNER BLVD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2539
Mailing Address - Country:US
Mailing Address - Phone:619-544-1056
Mailing Address - Fax:
Practice Address - Street 1:1601 KETTNER BLVD UNIT 11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2539
Practice Address - Country:US
Practice Address - Phone:619-544-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist