Provider Demographics
NPI:1790322741
Name:ASHBURN, TIFFANY LITTLE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LITTLE
Last Name:ASHBURN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 KENTWELL PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1280
Mailing Address - Country:US
Mailing Address - Phone:919-389-8108
Mailing Address - Fax:
Practice Address - Street 1:2800 KIDD RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1842
Practice Address - Country:US
Practice Address - Phone:919-389-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist