Provider Demographics
NPI:1619498169
Name:RUDKIN, TIFFINY C (LMT)
Entity Type:Individual
Prefix:MS
First Name:TIFFINY
Middle Name:C
Last Name:RUDKIN
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 1:6545 - 41ST AVE. N.
Mailing Address - Street 2:#8
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709
Mailing Address - Country:US
Mailing Address - Phone:727-207-4814
Mailing Address - Fax:
Practice Address - Street 1:3039 - 49TH ST. N.
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-344-8690
Practice Address - Fax:727-381-9390
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist