Provider Demographics
NPI:1164547089
Name:UPCHURCH, TIFFANY AMANDA (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:AMANDA
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62363 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-4927
Mailing Address - Country:US
Mailing Address - Phone:256-396-6242
Mailing Address - Fax:256-354-1294
Practice Address - Street 1:83825 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-1270
Practice Address - Country:US
Practice Address - Phone:256-354-2131
Practice Address - Fax:256-354-1294
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23549225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant