Provider Demographics
NPI:1063787711
Name:TINNIN, EMILY ROSE (PTA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:TINNIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 BUSTLETON LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3058
Mailing Address - Country:US
Mailing Address - Phone:019-384-4233
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:3209 BUSTLETON LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3058
Practice Address - Country:US
Practice Address - Phone:301-938-4423
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDA3812225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program