Provider Demographics
NPI:1225107543
Name:LYTLE, TIFFANY MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MARIE
Last Name:LYTLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:HANNAKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:141 SPRUCE CT
Mailing Address - Street 2:APT 2
Mailing Address - City:SALIX
Mailing Address - State:PA
Mailing Address - Zip Code:15952-9439
Mailing Address - Country:US
Mailing Address - Phone:814-487-5841
Mailing Address - Fax:
Practice Address - Street 1:807 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2942
Practice Address - Country:US
Practice Address - Phone:814-255-4921
Practice Address - Fax:814-255-4921
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHA1863318OtherHIGHMARK BLUE SHIELD