Provider Demographics
NPI:1932438249
Name:VENDELA, TIFFANY ROCHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROCHELLE
Last Name:VENDELA
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:PO BOX 711185
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-1185
Mailing Address - Country:US
Mailing Address - Phone:801-942-3311
Mailing Address - Fax:801-942-5955
Practice Address - Street 1:124 S FAIRFIELD RD
Practice Address - Street 2:STE A
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-7105
Practice Address - Country:US
Practice Address - Phone:801-547-9462
Practice Address - Fax:801-547-9116
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7797625-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT466502Medicare Oscar/Certification