MEDICARE: MS. TAMARA ANTONIA STOJADINOVIC M.A. RYT.

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	226300000X	Kinesiotherapist

General Provider Information

NPI Number	:	1114203734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA ANTONIA STOJADINOVIC M.A. RYT.

Provider Business Mailing Address
First Line	:	CALLE 25 #246 X 20 Y 22
Second Line	:
City	:	PROGRESO
State	:	MEXICO
Zip	:	97320
Country	:	MX
Telephone Number	:	817-984-9642
Fax Number	:

Provider Business Practice Location Address
First Line	:	9504 WATERCRESS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-4906
Country	:	US
Telephone Number	:	817-984-9642
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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