Provider Demographics
NPI:1568971885
Name:MARSHALL, TIFFANY (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:MARSHALL
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 1:12179 N BDALE RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47952-7022
Mailing Address - Country:US
Mailing Address - Phone:765-397-3279
Mailing Address - Fax:
Practice Address - Street 1:NORTH AT UAP BONE & JOINT CENTER
Practice Address - Street 2:LOWER LEVEL 1725 NORTH 5TH STREET
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804
Practice Address - Country:US
Practice Address - Phone:812-242-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012510A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist