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General NPI Number Information
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NPI Number | 1114485612
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Entity Type | Individual
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Provider Name | TIFFANY THOMAS ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 700 CONGRESS AVE
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3018
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Country | US
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Telephone | 410-939-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 4 TOPWOOD CT
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City | PARKVILLE
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State | MD
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Zip | 21234-1434
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A00686
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License Number State | MD
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