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General NPI Number Information
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NPI Number | 1174343883
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Entity Type | Organization
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Legal Business Name | AESTHETICA PLLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 45 E MONTEREY WAY STE 202
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City | PHOENIX
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State | AZ
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Zip | 85012-2757
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Country | US
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Telephone | 602-791-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 45 E MONTEREY WAY STE 202
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City | PHOENIX
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State | AZ
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Zip | 85012-2757
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Country | US
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Telephone | 602-791-0199
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. TIFFANY HARRIS
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Credential | PHD, CMOT, CSCS
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Telephone | 602-791-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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