Provider Demographics
NPI:1972297141
Name:SMITH, TIFFANY D (LMT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WEST PRINCESS ANNE RD
Mailing Address - Street 2:APT. A1
Mailing Address - City:NORFOLK VIRGINIA
Mailing Address - State:VA
Mailing Address - Zip Code:23517
Mailing Address - Country:US
Mailing Address - Phone:757-770-7078
Mailing Address - Fax:
Practice Address - Street 1:750 W PRINCESS ANNE RD
Practice Address - Street 2:APT. A1
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1840
Practice Address - Country:US
Practice Address - Phone:757-770-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019013508225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty