Provider Demographics
NPI:1548495161
Name:ROOT, TIFFANY LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:ROOT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 836 BOX 175
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636-0003
Mailing Address - Country:US
Mailing Address - Phone:314-624-4536
Mailing Address - Fax:
Practice Address - Street 1:US NMRTC SIGONELLA, EDIS DEPT
Practice Address - Street 2:NAS1 SIGONELLA
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09636
Practice Address - Country:US
Practice Address - Phone:314-624-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist