Provider Demographics
NPI:1649837832
Name:SOULES, TIFFANY RENE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENE
Last Name:SOULES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:AQUILLA
Mailing Address - State:TX
Mailing Address - Zip Code:76622
Mailing Address - Country:US
Mailing Address - Phone:254-266-3233
Mailing Address - Fax:
Practice Address - Street 1:101 N SAN MARCOS ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2652
Practice Address - Country:US
Practice Address - Phone:254-694-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2066986225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant