Provider Demographics
NPI:1710633003
Name:MUMA, TIFFANY E (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:E
Last Name:MUMA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:6070 W BELL RD STE A103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3774
Practice Address - Country:US
Practice Address - Phone:602-782-3965
Practice Address - Fax:602-715-0079
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020245225100000X
AZLPT-32889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist