Provider Demographics
NPI:1184033201
Name:GRAY, TIFFANY M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:GRAY
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 1:201 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2368
Mailing Address - Country:US
Mailing Address - Phone:724-746-1300
Mailing Address - Fax:724-746-0522
Practice Address - Street 1:201 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2368
Practice Address - Country:US
Practice Address - Phone:724-746-1300
Practice Address - Fax:724-746-0522
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist