Provider Demographics
NPI:1689837833
Name:KRIZ, TIFFANY DELISA (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DELISA
Last Name:KRIZ
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 BONITA BAY BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1702
Mailing Address - Country:US
Mailing Address - Phone:239-992-6700
Mailing Address - Fax:
Practice Address - Street 1:3501 BONITA BAY BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1702
Practice Address - Country:US
Practice Address - Phone:239-992-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT211442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic