Provider Demographics
NPI:1013067677
Name:TASSINARI, MARCIA I (MPT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:TASSINARI
Suffix:I
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 MISSION BLVD
Mailing Address - Street 2:STE. 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2541
Mailing Address - Country:US
Mailing Address - Phone:858-581-6900
Mailing Address - Fax:858-581-6999
Practice Address - Street 1:4747 MISSION BLVD
Practice Address - Street 2:STE. 4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2541
Practice Address - Country:US
Practice Address - Phone:858-581-6900
Practice Address - Fax:858-581-6999
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20362Medicare ID - Type UnspecifiedPHYSICAL THERAPIST