Provider Demographics
NPI:1497212583
Name:GOAD, TIFFANY (PTA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GOAD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0318
Mailing Address - Country:US
Mailing Address - Phone:682-556-9619
Mailing Address - Fax:
Practice Address - Street 1:2005 W PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2034
Practice Address - Country:US
Practice Address - Phone:817-375-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant