MEDICARE: TIFFANY VANN PT

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	PT29108	FL

General Provider Information

NPI Number	:	1396775565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY VANN PT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 UNIVERSITY PKWY STE 104
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32514-5485
Country	:	US
Telephone Number	:	850-208-6120
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	12/17/2025

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Directions to “ TIFFANY VANN PT” Practice Location

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