Provider Demographics
NPI:1871593483
Name:TENBRINK, JOEL D (PT, ATC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:TENBRINK
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 IRONWOOD CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2639
Mailing Address - Country:US
Mailing Address - Phone:208-667-6264
Mailing Address - Fax:208-664-4313
Practice Address - Street 1:2180 IRONWOOD CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2639
Practice Address - Country:US
Practice Address - Phone:208-667-6264
Practice Address - Fax:208-664-4313
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009604225100000X
IDPT-2077225100000X
IDAT-2912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7155104Medicaid
IDCG9010OtherRAILROAD MEDICARE
8850913Medicare ID - Type Unspecified
WA7155104Medicaid