Healthcare Provider Details

I. General information

NPI: 1992293955
Provider Name (Legal Business Name): TIFFANY TIMMERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALBANY THERAPEUTIC MASSAGE CLINIC 1534 DAWSON, RD
ALBANY GA
31707
US

IV. Provider business mailing address

ALBANY THERAPEUTIC MASSAGE CLINIC 1534 DAWSON. RD
ALBANY GA
31707
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-9008
  • Fax: 229-435-9080
Mailing address:
  • Phone: 229-435-9008
  • Fax: 229-435-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number009318
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: