Healthcare Provider Details

I. General information

NPI: 1912296302
Provider Name (Legal Business Name): MRS. TIFFANY LE'SHAUN HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W ARBROOK BLVD SUITE 200
ARLINGTON TX
76015-4327
US

IV. Provider business mailing address

335 ROSELANE ST NW SUITE 201
MARIETTA GA
30060-7902
US

V. Phone/Fax

Practice location:
  • Phone: 817-472-2200
  • Fax: 817-467-9021
Mailing address:
  • Phone: 470-259-5226
  • Fax: 267-321-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number1154498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: