Provider Demographics
NPI:1437402823
Name:TONGEN, TINA (RMT, AOS, CYT, NCTMB)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:TONGEN
Suffix:
Gender:F
Credentials:RMT, AOS, CYT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 GLENWOOD DR
Mailing Address - Street 2:APT 401
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1305
Mailing Address - Country:US
Mailing Address - Phone:720-398-7835
Mailing Address - Fax:
Practice Address - Street 1:3825 IRIS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2003
Practice Address - Country:US
Practice Address - Phone:720-398-7835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT11470225700000X
CO599389-10225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist