MEDICARE: TINOY MATAMANA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1288000	TX
2	225100000X	Physical Therapist	8241	AZ

General Provider Information

NPI Number	:	1942448238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINOY MATAMANA PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	5045 W BASELINE RD
Second Line	:	SUITE 120
City	:	LAVEEN
State	:	AZ
Zip	:	85339-7392
Country	:	US
Telephone Number	:	602-605-8982
Fax Number	:	602-237-8861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	11/25/2019

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Directions to “ TINOY MATAMANA PT” Practice Location

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