Provider Demographics
NPI:1144704354
Name:HARDY, TINO ENOCH (DPT)
Entity type:Individual
Prefix:
First Name:TINO
Middle Name:ENOCH
Last Name:HARDY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 SAN FELIPE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1546
Mailing Address - Country:US
Mailing Address - Phone:408-841-7203
Mailing Address - Fax:
Practice Address - Street 1:14103 WINCHESTER BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1835
Practice Address - Country:US
Practice Address - Phone:408-868-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist