Provider Demographics
NPI:1497145536
Name:BAKER, TIFFANY SUDOL (PT, DPT, CPT, CAC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:SUDOL
Last Name:BAKER
Suffix:
Gender:F
Credentials:PT, DPT, CPT, CAC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:SUDOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3522
Mailing Address - Country:US
Mailing Address - Phone:917-744-6457
Mailing Address - Fax:
Practice Address - Street 1:76 VALLEY RD
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2533
Practice Address - Country:US
Practice Address - Phone:917-744-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X
NY037938-12251X0800X
CT0103032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty