Provider Demographics
NPI:1952484669
Name:LEBENGOOD, TIFFANY LYN (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:LYN
Last Name:LEBENGOOD
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1106
Mailing Address - Country:US
Mailing Address - Phone:570-523-0890
Mailing Address - Fax:
Practice Address - Street 1:MOORE AVENUE
Practice Address - Street 2:BUCKNELL UNIVERSITY - KLARC
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:570-577-3049
Practice Address - Fax:570-577-1660
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002024A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer