Provider Demographics
NPI:1942571492
Name:BAXTER, TIFFANY ANN (ATC, RT(R), CMT)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:ATC, RT(R), CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 PINCHERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9162
Mailing Address - Country:US
Mailing Address - Phone:231-675-9556
Mailing Address - Fax:
Practice Address - Street 1:7371 PINCHERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9162
Practice Address - Country:US
Practice Address - Phone:231-675-9556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer