Provider Demographics
NPI:1114316239
Name:KRAUSE, TIFFANY LYNNE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNNE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ROBERTS LAKE CIRCLE
Mailing Address - Street 2:APT. 308
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-0497
Mailing Address - Country:US
Mailing Address - Phone:803-409-9688
Mailing Address - Fax:
Practice Address - Street 1:1000 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4800
Practice Address - Country:US
Practice Address - Phone:828-693-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006521225100000X
NC16061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist