Provider Demographics
NPI:1548514235
Name:WILKINSON, TIFFANY M (DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:MEADORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5027 ATWOOD DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8322
Mailing Address - Country:US
Mailing Address - Phone:859-625-0001
Mailing Address - Fax:859-625-0057
Practice Address - Street 1:185 FARRA DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-8764
Practice Address - Country:US
Practice Address - Phone:859-792-1228
Practice Address - Fax:859-792-1618
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist