Provider Demographics
NPI:1487040069
Name:CARTER, TIFFANY (ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:6704 W CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9226
Mailing Address - Country:US
Mailing Address - Phone:801-362-6637
Mailing Address - Fax:
Practice Address - Street 1:6704 W CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9226
Practice Address - Country:US
Practice Address - Phone:801-362-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer