Provider Demographics
NPI:1730350711
Name:COZZO, TIFFANY LEIGH (ATC)
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:LEIGH
Last Name:COZZO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 EAST UNION ROAD
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:RUSSELTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076
Mailing Address - Country:US
Mailing Address - Phone:412-779-8887
Mailing Address - Fax:
Practice Address - Street 1:163 EAST UNION ROAD
Practice Address - Street 2:
Practice Address - City:RUSSELTON
Practice Address - State:PA
Practice Address - Zip Code:15076
Practice Address - Country:US
Practice Address - Phone:412-779-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0033552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer