Provider Demographics
NPI:1174754303
Name:GRAHAM, TIFFANY (CPO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 HARRY HINES BLVD STE V2.302
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9091
Mailing Address - Country:US
Mailing Address - Phone:214-645-8250
Mailing Address - Fax:214-645-8258
Practice Address - Street 1:6011 HARRY HINES BLVD STE V2.302
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-645-8250
Practice Address - Fax:214-645-8258
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist