Provider Demographics
NPI:1013293141
Name:PAKKEBIER, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PAKKEBIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23996 RD Z
Mailing Address - Street 2:
Mailing Address - City:LENORA
Mailing Address - State:KS
Mailing Address - Zip Code:67645
Mailing Address - Country:US
Mailing Address - Phone:785-622-8433
Mailing Address - Fax:785-622-4222
Practice Address - Street 1:201 W. CRANE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654
Practice Address - Country:US
Practice Address - Phone:785-874-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02270225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant