Provider Demographics
NPI:1548518855
Name:MILROY, TIFFANY CRYSTAL
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CRYSTAL
Last Name:MILROY
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 1:113 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6007
Mailing Address - Country:US
Mailing Address - Phone:843-873-6004
Mailing Address - Fax:843-871-0400
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6007
Practice Address - Country:US
Practice Address - Phone:843-873-6004
Practice Address - Fax:843-871-0400
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist