Healthcare Provider Details

I. General information

NPI: 1518366921
Provider Name (Legal Business Name): TIFFANY MURPHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2745 MAPLE AVE 2D
LISLE IL
60532-3280
US

IV. Provider business mailing address

316 S BELMONT AVE
LISLE IL
60532
US

V. Phone/Fax

Practice location:
  • Phone: 630-778-6505
  • Fax:
Mailing address:
  • Phone: 630-778-6505
  • Fax: 630-396-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227013650
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: