Healthcare Provider Details

I. General information

NPI: 1952870909
Provider Name (Legal Business Name): TIFFANY SHERRI ANDERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MONTEVALLO RD STE B108
IRONDALE AL
35210-3128
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-2564
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-0870
  • Fax: 205-957-0872
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA6480
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: