Provider Demographics
NPI:1700470853
Name:RUKAVINA, TINA LOUISE (PTA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:RUKAVINA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9888 W BELLEVIEW AVE # 2233
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2101
Mailing Address - Country:US
Mailing Address - Phone:720-401-1244
Mailing Address - Fax:
Practice Address - Street 1:233 WHITE WAY ST
Practice Address - Street 2:
Practice Address - City:NETAWAKA
Practice Address - State:KS
Practice Address - Zip Code:66516-9323
Practice Address - Country:US
Practice Address - Phone:785-933-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA0012644225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant