MEDICARE: TIFFANY S PHILLIPS

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1710718739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY S PHILLIPS

Provider Business Mailing Address
First Line	:	431 MAPLE GROVE RD
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104
Country	:	US
Telephone Number	:	972-533-4177
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 W COMMERCE ST STE 3357
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	972-533-4177
Fax Number	:

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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Directions to “ TIFFANY S PHILLIPS ” Practice Location

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