Provider Demographics
NPI:1811926926
Name:BROGDON, TIFFANY DAY (DPTCSCS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAY
Last Name:BROGDON
Suffix:
Gender:F
Credentials:DPTCSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TOWN AND COUNTRY ST.
Mailing Address - Street 2:#230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 TOWN AND COUNTRY LN
Practice Address - Street 2:230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2226
Practice Address - Country:US
Practice Address - Phone:713-461-5050
Practice Address - Fax:713-461-5676
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1163641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G6072Medicare PIN