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General NPI Number Information
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NPI Number | 1295449247
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Entity Type | Individual
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Provider Name | TIFFANY THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 409 N THOMPSON ST
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City | SPRINGDALE
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State | AR
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Zip | 72764-4118
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Country | US
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Telephone | 479-750-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 14100 LAKE POINT DR
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City | LOWELL
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State | AR
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Zip | 72745-8653
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Country | US
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Telephone | 719-640-6842
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 31419
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1482
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License Number State | AR
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