Provider Demographics
NPI:1609495811
Name:REBHOLZ, TIFFANY DIANE (RRT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:DIANE
Last Name:REBHOLZ
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:DIANE
Other - Last Name:REBHOLZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRT
Mailing Address - Street 1:4809 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-3015
Mailing Address - Country:US
Mailing Address - Phone:304-588-7590
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1699
Practice Address - Country:US
Practice Address - Phone:740-374-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRCP.12589227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered