Provider Demographics
NPI:1508424847
Name:HORN, TIFFANY (PT,DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1814
Mailing Address - Country:US
Mailing Address - Phone:817-343-6444
Mailing Address - Fax:
Practice Address - Street 1:217 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1814
Practice Address - Country:US
Practice Address - Phone:817-343-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1317877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist