Provider Demographics
NPI:1750463931
Name:TIFFANY, DEBORAH K (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:K
Other - Last Name:HOLSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:405 W MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541
Mailing Address - Country:US
Mailing Address - Phone:928-474-0429
Mailing Address - Fax:928-474-0199
Practice Address - Street 1:405 W MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:928-474-0429
Practice Address - Fax:928-474-0199
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist