Provider Demographics
NPI:1194296996
Name:SALLEY, TIFFANY (PTA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SALLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-3111
Mailing Address - Country:US
Mailing Address - Phone:423-836-1167
Mailing Address - Fax:
Practice Address - Street 1:700 WILLIAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-7375
Practice Address - Country:US
Practice Address - Phone:865-986-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000006844225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant