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General NPI Number Information
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NPI Number | 1205455714
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Entity Type | Individual
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Provider Name | TIFFANEY WOODARD PTA
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 10023 BARR LAKE DR
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City | HOUSTON
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State | TX
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Zip | 77095-2373
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Country | US
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Telephone | 713-499-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 10023 BARR LAKE DR
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City | HOUSTON
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State | TX
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Zip | 77095-2373
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Country | US
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Telephone | 713-499-0020
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2152773
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License Number State | TX
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