Provider Demographics
NPI:1295452399
Name:VIEITEZ, TINA DANIELLE (DPT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:DANIELLE
Last Name:VIEITEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1529
Mailing Address - Country:US
Mailing Address - Phone:201-773-9700
Mailing Address - Fax:201-773-9701
Practice Address - Street 1:9 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1529
Practice Address - Country:US
Practice Address - Phone:201-773-9700
Practice Address - Fax:201-773-9701
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01942200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist