Provider Demographics
NPI:1700263951
Name:REAM, TIFFANIE ELISE (PTA)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:ELISE
Last Name:REAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 KIM WINONA CT
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-8847
Mailing Address - Country:US
Mailing Address - Phone:610-207-8349
Mailing Address - Fax:
Practice Address - Street 1:46 KIM WINONA CT
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-8847
Practice Address - Country:US
Practice Address - Phone:610-207-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010265225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant