Provider Demographics
NPI:1881935633
Name:PALMISANO, TIFFANY R (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:R
Last Name:PALMISANO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 HOLLY HALL ST APT 117
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3907
Mailing Address - Country:US
Mailing Address - Phone:609-432-2791
Mailing Address - Fax:
Practice Address - Street 1:2111 HOLLY HALL ST APT 117
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3907
Practice Address - Country:US
Practice Address - Phone:609-432-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206994225100000X
TX1211639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist