Provider Demographics
NPI:1306914940
Name:PRINCE, TIFFANY MARIE (MPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KING OF PRUSSIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4440
Mailing Address - Country:US
Mailing Address - Phone:610-341-9100
Mailing Address - Fax:
Practice Address - Street 1:320 KING OF PRUSSIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4440
Practice Address - Country:US
Practice Address - Phone:610-341-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist