Provider Demographics
NPI:1174884704
Name:WRIGHT, TIFFANY SADE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SADE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 GRAY ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9073
Mailing Address - Country:US
Mailing Address - Phone:702-355-2872
Mailing Address - Fax:
Practice Address - Street 1:319 GRAY ROBIN AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9073
Practice Address - Country:US
Practice Address - Phone:702-355-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner