Provider Demographics
NPI:1922126325
Name:ESPINOSA, MITZIE TANJUTCO (PT)
Entity Type:Individual
Prefix:
First Name:MITZIE
Middle Name:TANJUTCO
Last Name:ESPINOSA
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 1:127 FORGET ME NOT LN
Mailing Address - Street 2:APT. 2C
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1035
Mailing Address - Country:US
Mailing Address - Phone:956-763-0504
Mailing Address - Fax:
Practice Address - Street 1:401 UNIVERSITY DR
Practice Address - Street 2:THERAPY DEPT.
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-2211
Practice Address - Country:US
Practice Address - Phone:570-385-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGEA3036016200OtherBLUE CROSS PPO PROGRAM