Provider Demographics
NPI:1366607905
Name:TOMOVICH, KRISTINE K (DPT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:K
Last Name:TOMOVICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1641
Mailing Address - Country:US
Mailing Address - Phone:919-824-8619
Mailing Address - Fax:
Practice Address - Street 1:3363 BEECH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1641
Practice Address - Country:US
Practice Address - Phone:919-824-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43088225100000X
NC13670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist