Provider Demographics
NPI:1982053591
Name:ALBRACHT, TIFFANY (PT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ALBRACHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N KEENE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8145
Mailing Address - Country:US
Mailing Address - Phone:573-874-0001
Mailing Address - Fax:
Practice Address - Street 1:200 N KEENE ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8145
Practice Address - Country:US
Practice Address - Phone:573-874-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1273480225100000X
MO2021013136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359390101Medicaid
TX8FBA57OtherBCBS
TX359390101Medicaid