Provider Demographics
NPI:1265565337
Name:PIQUILLOUD, TIFFANY ALICE (PT)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ALICE
Last Name:PIQUILLOUD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 SAPPHIRE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1854
Mailing Address - Country:US
Mailing Address - Phone:619-838-8433
Mailing Address - Fax:
Practice Address - Street 1:5540 LAKE PARK WAY
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1607
Practice Address - Country:US
Practice Address - Phone:619-667-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-19378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist