Provider Demographics
NPI:1427206606
Name:TIFFANY, BRANDI (LMT)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BRANDA
Other - Middle Name:
Other - Last Name:TIFFANY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8075 SE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6565
Mailing Address - Country:US
Mailing Address - Phone:503-488-0081
Mailing Address - Fax:
Practice Address - Street 1:1567 SE TACOMA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6643
Practice Address - Country:US
Practice Address - Phone:503-488-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14405225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist