Provider Demographics
NPI:1679183362
Name:ST. LOUIS, SASHA TIFFANY (PT)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:TIFFANY
Last Name:ST. LOUIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 NW 66TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1310
Mailing Address - Country:US
Mailing Address - Phone:954-940-1233
Mailing Address - Fax:
Practice Address - Street 1:2833 EXECUTIVE PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3646
Practice Address - Country:US
Practice Address - Phone:954-353-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist