Provider Demographics
NPI:1134905409
Name:KANE, TIFFANY (LMT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KANE
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 1:301 4TH AVE N APT 602
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2924
Mailing Address - Country:US
Mailing Address - Phone:727-525-9887
Mailing Address - Fax:
Practice Address - Street 1:301 4TH AVE N APT 602
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2924
Practice Address - Country:US
Practice Address - Phone:727-525-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA94213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty