MEDICARE: KRISTINE K TOMOVICH DPT

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	225100000X	Physical Therapist	43088	CA
2	225100000X	Physical Therapist	13670	NC

General Provider Information

NPI Number	:	1366607905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE K TOMOVICH DPT

Provider Business Mailing Address
First Line	:	3363 BEECH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1641
Country	:	US
Telephone Number	:	919-824-8619
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 BEECH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1641
Country	:	US
Telephone Number	:	919-824-8619
Fax Number	:

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

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	10/30/2015

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