Provider Demographics
NPI:1457998312
Name:SILLIMAN COHEN, TIFFANY REI (LMT)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:REI
Last Name:SILLIMAN COHEN
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 1:4217 OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4006
Mailing Address - Country:US
Mailing Address - Phone:802-363-7886
Mailing Address - Fax:
Practice Address - Street 1:4305 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5382
Practice Address - Country:US
Practice Address - Phone:215-857-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01256400225700000X
PAMSG012368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist