Provider Demographics
NPI:1942348149
Name:GELLE, TIFFANY JOY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JOY
Last Name:GELLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1036
Mailing Address - Country:US
Mailing Address - Phone:313-432-0239
Mailing Address - Fax:
Practice Address - Street 1:127 S MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1791
Practice Address - Country:US
Practice Address - Phone:734-354-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant