Healthcare Provider Details

I. General information

NPI: 1154988806
Provider Name (Legal Business Name): TIFFANY BOONE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 OVERLOOK ROAD EXT
ARDEN NC
28704-7700
US

IV. Provider business mailing address

92 ORWELL DR
FLETCHER NC
28732-0696
US

V. Phone/Fax

Practice location:
  • Phone: 828-483-3521
  • Fax: 828-484-2189
Mailing address:
  • Phone: 918-698-3487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3123754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: