MEDICARE: DR. TIFFANY HARRIS PHD, CREBT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	224Y00000X	Clinical Exercise Physiologist
3	2255A2300X	Athletic Trainer
4	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1841978988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY HARRIS PHD, CREBT

Provider Business Mailing Address
First Line	:	45 E MONTEREY WAY # 202A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2753
Country	:	US
Telephone Number	:	602-791-0199
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 E MONTEREY WAY # 202A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2753
Country	:	US
Telephone Number	:	602-791-0199
Fax Number	:

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

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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