Provider Demographics
NPI:1932237328
Name:HOOPER, TINA (MPT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 GATEWAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2470
Mailing Address - Country:US
Mailing Address - Phone:650-345-2739
Mailing Address - Fax:650-345-2756
Practice Address - Street 1:1810 GATEWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2470
Practice Address - Country:US
Practice Address - Phone:650-345-2739
Practice Address - Fax:650-345-2756
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283472251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT283470Medicare PIN