| Doctor Name: | TISHA PINON |
| NPI Number: | 1407042864 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 106896 |
| Business Practice Address: | 750 W Cooper St Buffalo, MO - 656228662 |
| Business Phone Number: | 4173455413 |
| Business Fax Number: | 4173458674 |
| Mailing Address: | 1500 N Oakland Ave, BOLIVAR |
| State: | MO |
| Postal Code: | 656133011 |
| Phone Number: | 4173286258 |
| Fax Number: | 4173286242 |
| NPI Enumeration Date: | 09/19/2007 |
| NPI Last Update Date: | 09/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 106896 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |