Provider Demographics
NPI:1306021548
Name:STRICKERT, TIFFANY (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:STRICKERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:RATHBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2205 JEFFERSON DAVIS DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5221
Practice Address - Country:US
Practice Address - Phone:662-238-2800
Practice Address - Fax:662-238-2808
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029882-1225100000X
MSPT4841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist