Provider Demographics
NPI:1346832862
Name:NOEL, TIFFANY (PTA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NOEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:CASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W6439 PAUL RD
Mailing Address - Street 2:
Mailing Address - City:TONY
Mailing Address - State:WI
Mailing Address - Zip Code:54563-9619
Mailing Address - Country:US
Mailing Address - Phone:715-290-0093
Mailing Address - Fax:
Practice Address - Street 1:1001 E 11TH ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1455
Practice Address - Country:US
Practice Address - Phone:715-532-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3097225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant