Provider Demographics
NPI:1659703999
Name:HODGES, TIFFANY ELLEN (DPT, OMPT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ELLEN
Last Name:HODGES
Suffix:
Gender:F
Credentials:DPT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8987 E TANQUE VERDE RD # 104
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9610
Mailing Address - Country:US
Mailing Address - Phone:520-884-9819
Mailing Address - Fax:520-884-0175
Practice Address - Street 1:1777 W SAINT MARYS RD
Practice Address - Street 2:#206
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2687
Practice Address - Country:US
Practice Address - Phone:520-884-9819
Practice Address - Fax:520-884-0175
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist