Healthcare Provider Details

I. General information

NPI: 1851880611
Provider Name (Legal Business Name): TIFFANY ANGELIQUE HUFF PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S SOUTH ST STE 100
MOUNT AIRY NC
27030-4599
US

IV. Provider business mailing address

314 S SOUTH ST STE 100
MOUNT AIRY NC
27030-4599
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-7129
  • Fax: 336-719-7396
Mailing address:
  • Phone: 336-719-7129
  • Fax: 336-719-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5616
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: