Healthcare Provider Details

I. General information

NPI: 1548574379
Provider Name (Legal Business Name): ROBERT LOUIS TENDICK P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 GREENFIELD DR
EL CAJON CA
92021-3520
US

IV. Provider business mailing address

317 N EL CAMINO REAL #210
ENCINITAS CA
92024-2811
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-5752
  • Fax: 619-440-6861
Mailing address:
  • Phone: 760-634-0248
  • Fax: 760-634-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 36981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: