Provider Demographics
NPI:1750105615
Name:BADRA, TINA JOHNI
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:JOHNI
Last Name:BADRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 KATHLEEN ANN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1522
Mailing Address - Country:US
Mailing Address - Phone:636-248-8183
Mailing Address - Fax:
Practice Address - Street 1:3652 KATHLEEN ANN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1522
Practice Address - Country:US
Practice Address - Phone:636-248-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist