Provider Demographics
NPI:1598048027
Name:KOUADIO, TIFFANY (DPT)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:
Last Name:KOUADIO
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 1:332 W 806 N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-7973
Mailing Address - Country:US
Mailing Address - Phone:219-764-4888
Mailing Address - Fax:219-764-7676
Practice Address - Street 1:809 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4528
Practice Address - Country:US
Practice Address - Phone:229-469-6932
Practice Address - Fax:229-469-6933
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99048622A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist