Provider Demographics
NPI:1588796650
Name:PITRE, TIFFANY N (DPT, PT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:N
Last Name:PITRE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 HOLDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8807
Mailing Address - Country:US
Mailing Address - Phone:210-535-0096
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DRIVE
Practice Address - Street 2:ATTN: MCHE-ZQQ
Practice Address - City:JBSA FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8379225200000X
FLPT34121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant