Healthcare Provider Details

I. General information

NPI: 1629355318
Provider Name (Legal Business Name): TIFFANI ALLAIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TAVISTOCK LAKES BLVD STE 400
ORLANDO FL
32827-7593
US

IV. Provider business mailing address

526 KETTERING RD
DAVENPORT FL
33897-7743
US

V. Phone/Fax

Practice location:
  • Phone: 407-970-0824
  • Fax:
Mailing address:
  • Phone: 951-722-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29964
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 9119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: