Provider Demographics
NPI:1144653932
Name:SADECK, TIFFANY PRISCILLA
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PRISCILLA
Last Name:SADECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ATTUCKS LN
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1867
Mailing Address - Country:US
Mailing Address - Phone:508-778-5000
Mailing Address - Fax:508-778-5508
Practice Address - Street 1:735 ATTUCKS LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1867
Practice Address - Country:US
Practice Address - Phone:508-778-5000
Practice Address - Fax:508-778-5508
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist