Provider Demographics
NPI:1134786007
Name:CALFEE, TIFFANY (DPT)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:CALFEE
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 1:5700 LAKELAND AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429
Mailing Address - Country:US
Mailing Address - Phone:763-535-7607
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKELAND AVE N STE 200
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429
Practice Address - Country:US
Practice Address - Phone:763-535-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99093336A225100000X
IN05013524A225100000X
MN12448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300029745Medicaid
IN471400582OtherMEDICARE