Provider Demographics
NPI:1437607868
Name:FRITZ, TIFFANY ANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ANN
Last Name:FRITZ
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 1:136 LAKE STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522
Mailing Address - Country:US
Mailing Address - Phone:717-466-5880
Mailing Address - Fax:
Practice Address - Street 1:136 LAKE STREET
Practice Address - Street 2:SUITE E
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522
Practice Address - Country:US
Practice Address - Phone:717-466-5880
Practice Address - Fax:717-980-2754
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031751930001Medicaid