MEDICARE: MISS JOANNA TINGWALD

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	225200000X	Physical Therapy Assistant	2073483	TX

General Provider Information

NPI Number	:	1740558758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOANNA TINGWALD

Provider Business Mailing Address
First Line	:	134 BIRCHWOOD DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-3038
Country	:	US
Telephone Number	:	512-736-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WEST LOOP S STE 1525
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3508
Country	:	US
Telephone Number	:	713-965-9998
Fax Number	:	713-965-9921

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

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Directions to “ MISS JOANNA TINGWALD ” Practice Location

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