Provider Demographics
NPI:1740580067
Name:BOSHANE, TIFFANY ANNE (PTA)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANNE
Last Name:BOSHANE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 ZIBLUT CT
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1855
Mailing Address - Country:US
Mailing Address - Phone:716-622-7983
Mailing Address - Fax:
Practice Address - Street 1:8337 ZIBLUT CT
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1855
Practice Address - Country:US
Practice Address - Phone:716-622-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17052225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant