Healthcare Provider Details

I. General information

NPI: 1922391267
Provider Name (Legal Business Name): TIFFANY ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 S PEARL ST SUITE 40
DENVER CO
80210-3161
US

IV. Provider business mailing address

1855 S PEARL ST SUITE 40
DENVER CO
80210-3161
US

V. Phone/Fax

Practice location:
  • Phone: 303-733-0943
  • Fax:
Mailing address:
  • Phone: 303-733-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY D WATSON
Title or Position: OWNER
Credential: M.P.T.
Phone: 303-733-0943