Provider Demographics
NPI:1265137277
Name:NISH, TIFFANY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NISH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MARKLE HALL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1712
Mailing Address - Country:US
Mailing Address - Phone:610-330-5491
Mailing Address - Fax:610-330-5811
Practice Address - Street 1:700 W. PIERCE ST
Practice Address - Street 2:KIRBY SPORTS CENTER
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1712
Practice Address - Country:US
Practice Address - Phone:610-330-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0044132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer