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General NPI Number Information
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NPI Number | 1144704354
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Entity Type | Individual
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Provider Name | TINO ENOCH HARDY DPT
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Gender | Male
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 14103 WINCHESTER BLVD STE F
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City | LOS GATOS
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State | CA
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Zip | 95032-1835
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Country | US
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Telephone | 408-868-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 SAN FELIPE RD STE 100
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City | SAN JOSE
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State | CA
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Zip | 95135-1546
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Country | US
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Telephone | 408-841-7203
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 295209
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License Number State | CA
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