MEDICARE: TIFFANY MOTLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A-1293	NV

General Provider Information

NPI Number	:	1043838204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MOTLEY

Provider Business Mailing Address
First Line	:	852 ROYAL AMETHYST WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2432
Country	:	US
Telephone Number	:	702-545-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	852 ROYAL AMETHYST WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-2432
Country	:	US
Telephone Number	:	702-545-8811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	06/16/2025

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Directions to “ TIFFANY MOTLEY ” Practice Location

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