Provider Demographics
NPI:1740307115
Name:ROSSINO, TINA MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:ROSSINO
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 1:38 VILLAGE RD
Mailing Address - Street 2:UNIT 515
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-1260
Mailing Address - Country:US
Mailing Address - Phone:978-774-4219
Mailing Address - Fax:
Practice Address - Street 1:178 LOWELL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2719
Practice Address - Country:US
Practice Address - Phone:781-862-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3524225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant