Provider Demographics
NPI:1184974065
Name:DELANGE, TIFFANY ROSE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ROSE
Last Name:DELANGE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:THALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 5300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8016
Mailing Address - Country:US
Mailing Address - Phone:269-375-9450
Mailing Address - Fax:269-375-9465
Practice Address - Street 1:175 MARCELL DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1365
Practice Address - Country:US
Practice Address - Phone:616-866-0141
Practice Address - Fax:269-375-9465
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist