Provider Demographics
NPI:1992039770
Name:JOHNSON, TIFFANY M (DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 ENTERPRISE WAY NW STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4472
Mailing Address - Country:US
Mailing Address - Phone:256-713-1872
Mailing Address - Fax:256-713-1873
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8999
Practice Address - Country:US
Practice Address - Phone:256-461-9654
Practice Address - Fax:256-461-9728
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8499225100000X
ALPTH5807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51109605OtherBCBS
TN0446631Medicaid
051112329OtherBCBS
102I658881Medicare PIN
AL51109605OtherBCBS