Provider Demographics
NPI:1972841724
Name:ISABELLA, TINA (PT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ISABELLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:VITELLARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3820 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:832 PRINCETON AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1320
Practice Address - Country:US
Practice Address - Phone:205-206-8231
Practice Address - Fax:205-206-8337
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist