Healthcare Provider Details

I. General information

NPI: 1295214948
Provider Name (Legal Business Name): TORI HAFFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 N LOOP 1604 E STE 101
LIVE OAK TX
78233-2799
US

IV. Provider business mailing address

7505 N LOOP 1604 E STE 101
LIVE OAK TX
78233-2799
US

V. Phone/Fax

Practice location:
  • Phone: 210-590-4000
  • Fax:
Mailing address:
  • Phone: 210-590-4000
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1307622
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: