Provider Demographics
NPI:1215731849
Name:SEGARRA, TIFFANY (LMT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SEGARRA
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 HAY TER STE LL6
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4650
Mailing Address - Country:US
Mailing Address - Phone:610-714-3063
Mailing Address - Fax:
Practice Address - Street 1:1901 HAY TER STE LL6
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4650
Practice Address - Country:US
Practice Address - Phone:610-714-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG014647225700000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist