Provider Demographics
NPI:1316360217
Name:RATHWELL, TIFFANY (ATC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:RATHWELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24932 AURORA RD STE C
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1790
Mailing Address - Country:US
Mailing Address - Phone:440-439-9440
Mailing Address - Fax:440-439-1808
Practice Address - Street 1:24932 AURORA RD STE C
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1790
Practice Address - Country:US
Practice Address - Phone:440-439-9440
Practice Address - Fax:440-439-1808
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0049092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer