Provider Demographics
NPI:1285859405
Name:VIRAG, TIFFANY SUSAN (DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SUSAN
Last Name:VIRAG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E MIFFLIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4205
Mailing Address - Country:US
Mailing Address - Phone:608-957-7088
Mailing Address - Fax:
Practice Address - Street 1:44 E MIFFLIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4205
Practice Address - Country:US
Practice Address - Phone:608-957-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011385225100000X
MI1760332225100000X
WI10862-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTVIRAGMedicaid
MITVIRAGMedicaid
WI1285859405Medicaid
WITVIRAGMedicaid
OHTVIRAGMedicaid
MITVIRAGMedicaid