Provider Demographics
NPI:1851627863
Name:TIMM, TIFFANY RAE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:RAE
Last Name:TIMM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3550 AIRPORT WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4760
Mailing Address - Country:US
Mailing Address - Phone:907-374-4911
Mailing Address - Fax:907-374-4934
Practice Address - Street 1:3550 AIRPORT WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4760
Practice Address - Country:US
Practice Address - Phone:907-374-4911
Practice Address - Fax:907-374-4934
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant