Provider Demographics
NPI:1609649516
Name:FRYER, TIFFANY (LMT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:FRYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-0011
Mailing Address - Country:US
Mailing Address - Phone:937-981-1992
Mailing Address - Fax:937-981-1991
Practice Address - Street 1:1460 JEFFERSON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123
Practice Address - Country:US
Practice Address - Phone:937-981-1992
Practice Address - Fax:937-981-1991
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist