Healthcare Provider Details

I. General information

NPI: 1629984240
Provider Name (Legal Business Name): TIFFANY LYNN DUFOUR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY GROVE

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 NORTHWEST FWY
JERSEY VILLAGE TX
77040-1114
US

IV. Provider business mailing address

17360 NORTHWEST FWY
JERSEY VILLAGE TX
77040-1114
US

V. Phone/Fax

Practice location:
  • Phone: 713-849-2253
  • Fax:
Mailing address:
  • Phone: 713-849-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2187725
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: