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General NPI Number Information
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NPI Number | 1114203734
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Entity Type | Individual
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Provider Name | TAMARA ANTONIA STOJADINOVIC M.A. RYT.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 9504 WATERCRESS DR
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City | FORT WORTH
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State | TX
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Zip | 76135-4906
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Country | US
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Telephone | 817-984-9642
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 25 #246 X 20 Y 22
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City | PROGRESO
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State | MEXICO
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Zip | 97320
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Country | MX
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Telephone | 817-984-9642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number |
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License Number State |
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