Healthcare Provider Details

I. General information

NPI: 1992966899
Provider Name (Legal Business Name): TIFFANY HARDISON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

8129 BROKEN ROCK CV
CORDOVA TN
38016-6068
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-5180
  • Fax:
Mailing address:
  • Phone: 901-643-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT010588
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2305204922
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT7650
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT 27733
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1170668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: