Provider Demographics
NPI:1811205321
Name:WEISER, TIFFANY (DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WEISER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 I-35 SOUTH
Mailing Address - Street 2:STE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741
Mailing Address - Country:US
Mailing Address - Phone:512-394-0652
Mailing Address - Fax:512-394-1436
Practice Address - Street 1:2211 I-35 SOUTH
Practice Address - Street 2:STE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741
Practice Address - Country:US
Practice Address - Phone:512-394-0652
Practice Address - Fax:512-394-1436
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX207164901Medicaid
TX456606Medicare PIN
TX149984001Medicaid