Provider Demographics
NPI:1700505328
Name:SO, TIFFANY ANN (PT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:SO
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 1:41 N GARFIELD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7501
Mailing Address - Country:US
Mailing Address - Phone:626-782-7611
Mailing Address - Fax:626-782-7612
Practice Address - Street 1:41 N GARFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7501
Practice Address - Country:US
Practice Address - Phone:626-782-7611
Practice Address - Fax:626-782-7612
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist