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General NPI Number Information
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NPI Number | 1174754303
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Entity Type | Individual
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Provider Name | TIFFANY GRAHAM CPO
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Gender | Female
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 6011 HARRY HINES BLVD STE V2.302
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City | DALLAS
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State | TX
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Zip | 75390
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Country | US
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Telephone | 214-645-8250
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Fax | 214-645-8258
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Provider Business Mailing Address
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Address Line | 6011 HARRY HINES BLVD STE V2.302
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City | DALLAS
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State | TX
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Zip | 75390-9091
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Country | US
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Telephone | 214-645-8250
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Fax | 214-645-8258
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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