Provider Demographics
NPI:1851496541
Name:TIFFANY, JUNG HEE (RPT)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:HEE
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5094 S BURROWS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2054
Mailing Address - Country:US
Mailing Address - Phone:417-886-8612
Mailing Address - Fax:
Practice Address - Street 1:2810 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2524
Practice Address - Country:US
Practice Address - Phone:417-624-2061
Practice Address - Fax:417-624-2156
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMORO723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist