Provider Demographics
NPI:1801760145
Name:TINA DEGEORGE PHYSICAL THERAPIST, PLLC
Entity type:Organization
Organization Name:TINA DEGEORGE PHYSICAL THERAPIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:716-698-2428
Mailing Address - Street 1:4360 AUTUMN TRL
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2301
Mailing Address - Country:US
Mailing Address - Phone:716-698-2428
Mailing Address - Fax:716-698-2428
Practice Address - Street 1:4360 AUTUMN TRL
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2301
Practice Address - Country:US
Practice Address - Phone:716-698-2428
Practice Address - Fax:716-698-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty