Provider Demographics
NPI:1609263359
Name:TANGEN, TIFFANY MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE
Last Name:TANGEN
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 1:791 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3835
Mailing Address - Country:US
Mailing Address - Phone:862-432-5441
Mailing Address - Fax:
Practice Address - Street 1:791 WOODMONT DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3835
Practice Address - Country:US
Practice Address - Phone:862-432-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist