Basic Information
| Provider Information | |||||||||
| NPI: | 1437387966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 BROOKSIDE ST | ||||||||
| Address2: | |||||||||
| City: | WATERPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145719726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854065216 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 COMMUNITY DR | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165055630 | ||||||||
| FaxNumber: | 7168921936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 02/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 007359 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.