Provider Demographics
NPI:1013588391
Name:MCGINNIS, JOANNE SHURU-TAN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:SHURU-TAN
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JOANNE
Other - Middle Name:SHURU
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1035 COLEMAN RD APT 7115
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-6703
Mailing Address - Country:US
Mailing Address - Phone:615-974-6435
Mailing Address - Fax:
Practice Address - Street 1:1035 COLEMAN RD APT 7115
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6703
Practice Address - Country:US
Practice Address - Phone:615-974-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300192225100000X
TN11751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist