Provider Demographics
NPI:1871233767
Name:CANCINO, KARINA (PTA)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:CANCINO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8059 STAGE HILLS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4071
Mailing Address - Country:US
Mailing Address - Phone:901-383-4515
Mailing Address - Fax:
Practice Address - Street 1:8059 STAGE HILLS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4071
Practice Address - Country:US
Practice Address - Phone:901-383-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000007531225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty