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General NPI Number Information
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NPI Number | 1508341892
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Entity Type | Individual
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Provider Name | TIFANIE DANIELS MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 1558 MONTGOMERY HWY STE 7
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City | DOTHAN
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State | AL
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Zip | 36303-3300
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Country | US
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Telephone | 334-439-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 104 KENSINGTON CT
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City | DOTHAN
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State | AL
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Zip | 36303-9348
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Country | US
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Telephone | 334-435-0471
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3879
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License Number State | AL
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