Provider Demographics
NPI:1215547062
Name:NAVARRETE, TIFFANY RYON (PT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RYON
Last Name:NAVARRETE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RYON
Other - Last Name:CAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 GRUENE HVN
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3397
Mailing Address - Country:US
Mailing Address - Phone:361-876-5278
Mailing Address - Fax:
Practice Address - Street 1:147 GRUENE HVN
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-3397
Practice Address - Country:US
Practice Address - Phone:361-876-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist