Provider Demographics
NPI:1083735153
Name:GOODING, TIFFANY N (PT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:GOODING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 6TH ST S
Mailing Address - Street 2:DRSA #00-7700
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4827
Mailing Address - Country:US
Mailing Address - Phone:727-767-3231
Mailing Address - Fax:
Practice Address - Street 1:880 6TH ST S
Practice Address - Street 2:DRSA #00-7700
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4827
Practice Address - Country:US
Practice Address - Phone:727-767-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist