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General NPI Number Information
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NPI Number | 1528889169
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Entity Type | Individual
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Provider Name | TIFFANY DENEEN BOYLAN PTA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 2745 EXECUTIVE PARK NW
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City | CLEVELAND
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State | TN
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Zip | 37312-2723
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Country | US
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Telephone | 423-479-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 448 COOKSON CREEK RD
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City | OCOEE
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State | TN
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Zip | 37361-3841
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Country | US
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Telephone | 423-762-6171
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA0000006327
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License Number State | TN
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