MEDICARE: TIFFANY MCCONAHAY TACTO PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT009364	GA

General Provider Information

NPI Number	:	1316101983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MCCONAHAY TACTO PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-362-8684

Provider Business Practice Location Address
First Line	:	105 N MAIN ST
Second Line	:	STE C
City	:	CLEVELAND
State	:	GA
Zip	:	30528-1123
Country	:	US
Telephone Number	:	706-219-4507
Fax Number	:	706-865-1501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	11/18/2019

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