Provider Demographics
NPI:1720842164
Name:MIKKOLA, TIFFANY BROOKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BROOKE
Last Name:MIKKOLA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4236
Mailing Address - Country:US
Mailing Address - Phone:423-609-3906
Mailing Address - Fax:423-609-3907
Practice Address - Street 1:1321 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4236
Practice Address - Country:US
Practice Address - Phone:423-609-3906
Practice Address - Fax:423-609-3907
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist