Provider Demographics
NPI:1235307364
Name:MELTON, TIFFANY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:MELTON
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 1:615 FARRIS RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4904
Mailing Address - Country:US
Mailing Address - Phone:501-733-3112
Mailing Address - Fax:
Practice Address - Street 1:385 HIGHWAY 65 N
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-3506
Practice Address - Country:US
Practice Address - Phone:817-688-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166894721Medicaid