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General NPI Number Information
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NPI Number | 1780483453
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Entity Type | Individual
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Provider Name | TIFFANY RENE' SHEAR PTA
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Gender | Female
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 500 MEDICAL PARK DR
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City | DOVER
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State | OH
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Zip | 44622-3204
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Country | US
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Telephone | 330-602-0719
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Fax |
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Provider Business Mailing Address
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Address Line | 155 17TH ST NE
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City | NEW PHILADELPHIA
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State | OH
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Zip | 44663-3209
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Country | US
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Telephone | 330-933-3965
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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 | 08037
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License Number State | OH
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