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General NPI Number Information
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NPI Number | 1063160539
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Entity Type | Individual
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Provider Name | SANDRA TIGHE PTA
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Gender | Female
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 44600 5 MILE RD
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City | NORTHVILLE
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State | MI
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Zip | 48168-9602
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Country | US
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Telephone | 984-238-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 5150 W ELLSWORTH RD
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City | ANN ARBOR
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State | MI
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Zip | 48103-8907
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Country | US
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Telephone | 734-277-5578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502006209
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License Number State | MI
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