Provider Demographics
NPI:1922464841
Name:TRUXAW, TIFFANY (PTA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:TRUXAW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LINA
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1406 E HOUSTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5346
Mailing Address - Country:US
Mailing Address - Phone:361-542-4652
Mailing Address - Fax:361-542-5653
Practice Address - Street 1:1406 E HOUSTON ST UNIT D
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5346
Practice Address - Country:US
Practice Address - Phone:361-542-4652
Practice Address - Fax:361-362-1369
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2097010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant