Provider Demographics
NPI:1518094119
Name:STINSON, TIFFANY L (DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:STINSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 S SISK DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-1443
Mailing Address - Country:US
Mailing Address - Phone:765-748-6175
Mailing Address - Fax:765-381-0940
Practice Address - Street 1:2213 S SISK DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-1443
Practice Address - Country:US
Practice Address - Phone:765-748-6175
Practice Address - Fax:765-381-0940
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007686A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist