Provider Demographics
NPI:1083961619
Name:TRIBBLE, TYFFANY JADE (DPT)
Entity Type:Individual
Prefix:
First Name:TYFFANY
Middle Name:JADE
Last Name:TRIBBLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 W LANVALE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4451 PARLIAMENT PL
Practice Address - Street 2:SUITE G
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1843
Practice Address - Country:US
Practice Address - Phone:301-459-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist