Provider Demographics
NPI:1932852175
Name:NEW, TIFFANY (LMT, PTA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:NEW
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, PTA
Mailing Address - Street 1:321 LAGONDA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2817
Mailing Address - Country:US
Mailing Address - Phone:513-213-8022
Mailing Address - Fax:
Practice Address - Street 1:14 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2704
Practice Address - Country:US
Practice Address - Phone:513-213-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017254225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist