Provider Demographics
NPI:1508341892
Name:DANIELS, TIFANIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:TIFANIE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-9348
Mailing Address - Country:US
Mailing Address - Phone:334-435-0471
Mailing Address - Fax:
Practice Address - Street 1:1558 MONTGOMERY HWY STE 7
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3300
Practice Address - Country:US
Practice Address - Phone:334-439-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty