Provider Demographics
NPI:1649445743
Name:MCCAIN, TIFFANY CELESTE (PT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CELESTE
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CELESTE
Other - Last Name:ENNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:221 W FIR AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0221
Mailing Address - Country:US
Mailing Address - Phone:559-325-3444
Mailing Address - Fax:559-325-7444
Practice Address - Street 1:221 W FIR AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0221
Practice Address - Country:US
Practice Address - Phone:559-325-3444
Practice Address - Fax:559-325-7444
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist