Provider Demographics
NPI:1518772730
Name:DAGOSTINO, TIFFANY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DAGOSTINO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 COURTLAND DR NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7243
Mailing Address - Country:US
Mailing Address - Phone:616-863-9482
Mailing Address - Fax:616-863-9486
Practice Address - Street 1:6769 COURTLAND DR NE STE 100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7243
Practice Address - Country:US
Practice Address - Phone:616-863-9482
Practice Address - Fax:616-863-9486
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist