Tina Marie Blythe

Primary specialty

SpecialistTaxonomy code 174400000X

License

138 Issued in CA

Practice address

2560 N Texas St Ste J
Fairfield, CA 94533-1649

Phone

(707) 330-6949

Fax

(707) 425-2543

NPI assigned

Oct 7, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Therapy Works

  • Rehabilitation Clinic/Center
  • Fairfield, CA
  • NPI 1275781700
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1689825762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 N TEXAS ST STE J",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945331649",
            "telephone_number": "707-330-6949",
            "fax_number": "707-425-2543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 N TEXAS ST STE J",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945331649",
            "telephone_number": "707-330-6949",
            "fax_number": "707-425-2543"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Empire St",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CA",
            "postal_code": "945335702",
            "country_code": "US",
            "telephone_number": "707-425-5744",
            "fax_number": "707-425-5162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLYTHE",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-07",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Bloom, M.D.
• Niya Blue
• Michel'Le Blueford
• Tracy Lynn Blunt, M.S.W.
• Ashlee Blystone
• Corrine Boatwright
• Malcolm Bobino
• Nancy Ivette Bocanegra
• Gary E Bocci, D.C.
• Body in Balance Physical Therapy, Inc.

• Specialist in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.