MEDICARE: TIFFANY DAY BROGDON DPTCSCS

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	225100000X	Physical Therapist	1163641	TX

General Provider Information

NPI Number	:	1811926926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DAY BROGDON DPTCSCS

Provider Business Mailing Address
First Line	:	900 TOWN AND COUNTRY ST.
Second Line	:	#230
City	:	HOUSTON
State	:	TX
Zip	:	77024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 TOWN AND COUNTRY LN
Second Line	:	230
City	:	HOUSTON
State	:	TX
Zip	:	77024-2226
Country	:	US
Telephone Number	:	713-461-5050
Fax Number	:	713-461-5676

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	10/28/2008

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