MEDICARE: TIFFANIE TUPA 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	1123453	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1252510001	OTHER	TX	MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8T4173	OTHER	TX	BCBS
3	1123453	OTHER	TX	PT STATE LICENSE
4	Q44964	OTHER	TX	UPIN NUMBER

General Provider Information

NPI Number	:	1871619544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANIE TUPA PT

Provider Business Mailing Address
First Line	:	21 SPURS LN
Second Line	:	SUITE 320
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1634
Country	:	US
Telephone Number	:	210-558-4263
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 SPURS LN
Second Line	:	SUITE 320
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1634
Country	:	US
Telephone Number	:	210-558-4263
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/14/2008

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Directions to “ TIFFANIE TUPA PT” Practice Location

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