Provider Demographics
NPI:1700909264
Name:TIGHE, JOSEPH VINCENT (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:TIGHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W HORTTER ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3653
Mailing Address - Country:US
Mailing Address - Phone:215-266-9173
Mailing Address - Fax:
Practice Address - Street 1:400 W HORTTER ST
Practice Address - Street 2:UNIT C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-3653
Practice Address - Country:US
Practice Address - Phone:215-266-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009953L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA020904OtherBCBS OF PENNSYLVANIA
PA0460235000OtherBLUE SHIELD PERSONAL CHOI
PA024382Medicare ID - Type Unspecified