Provider Demographics
NPI:1639521719
Name:WOOD, TIFFANI (ATC)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 DOREEN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3353
Mailing Address - Country:US
Mailing Address - Phone:515-408-3027
Mailing Address - Fax:
Practice Address - Street 1:1120 DOREEN AVE APT 1
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3353
Practice Address - Country:US
Practice Address - Phone:515-408-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2000025845390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program