MEDICARE: TIFFANI MICHEL 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	PT015143	GA

General Provider Information

NPI Number	:	1396338729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI MICHEL DPT

Provider Business Mailing Address
First Line	:	982 MEMORIAL DR SE APT 107
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-4419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 N AVONDALE RD
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1319
Country	:	US
Telephone Number	:	470-649-3626
Fax Number	:	470-839-6922

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

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	11/04/2024

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Directions to “ TIFFANI MICHEL DPT” Practice Location

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