Provider Demographics
NPI:1740648518
Name:PATTERSON, TIFFANY HINESLEY (DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:HINESLEY
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7951
Mailing Address - Country:US
Mailing Address - Phone:919-563-1825
Mailing Address - Fax:919-563-1833
Practice Address - Street 1:1225 HUFFMAN MILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8788
Practice Address - Country:US
Practice Address - Phone:336-584-7689
Practice Address - Fax:336-584-8063
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG76041Medicaid
NCG76041Medicaid