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General NPI Number Information
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NPI Number | 1861619793
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Entity Type | Individual
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Provider Name | TIFFANY ROSE KNIGHTEN CMT
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1510 E RICHARDS ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2941
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Country | US
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Telephone | 307-351-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 CASPAR CT
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City | DOUGLAS
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State | WY
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Zip | 82633-2856
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Country | US
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Telephone | 307-351-1711
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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 |
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License Number State | WY
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