Healthcare Provider Details

I. General information

NPI: 1861780421
Provider Name (Legal Business Name): TIFFANY SCHROEDER ATC, LAT, DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 S MENDENHALL RD
MEMPHIS TN
38115-5914
US

IV. Provider business mailing address

PO BOX 38832
GERMANTOWN TN
38183-0832
US

V. Phone/Fax

Practice location:
  • Phone: 901-365-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8961
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: