Healthcare Provider Details

I. General information

NPI: 1558841312
Provider Name (Legal Business Name): TINA MARIE TIHEN PHYSICAL THERAPIST A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TINA MARIE TIHEN

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 WASHINGTON RD
KENOSHA WI
53144-1654
US

IV. Provider business mailing address

2120 32ND ST
KENOSHA WI
53140-2211
US

V. Phone/Fax

Practice location:
  • Phone: 262-653-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number981-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: