Provider Demographics
NPI:1700085065
Name:TYNDALL WILSON, TINA NICOLE (PT)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:NICOLE
Last Name:TYNDALL WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:NICOLE
Other - Last Name:TYNDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:868 WRIGLEY LN SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-4600
Mailing Address - Country:US
Mailing Address - Phone:408-209-4099
Mailing Address - Fax:
Practice Address - Street 1:410 PROVIDENCE LN NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-493-4995
Practice Address - Fax:360-493-7977
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist