Provider Demographics
NPI:1285013789
Name:LOCKWOOD, TIFFANY LEE (CRT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LEE
Other - Last Name:UPSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRT
Mailing Address - Street 1:1125 W 2600 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5312
Mailing Address - Country:US
Mailing Address - Phone:801-604-8951
Mailing Address - Fax:
Practice Address - Street 1:3540 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4435
Practice Address - Country:US
Practice Address - Phone:801-977-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8406954-57012278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation