Provider Demographics
NPI:1023616521
Name:CHI, TIFFANY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:CHI
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 1:1124 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7227
Mailing Address - Country:US
Mailing Address - Phone:415-812-9264
Mailing Address - Fax:
Practice Address - Street 1:2311 W 22ND ST STE 110
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1261
Practice Address - Country:US
Practice Address - Phone:630-912-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist