Provider Demographics
NPI:1366810285
Name:MCKLEROY, TIFFANY (DPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MCKLEROY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1717
Mailing Address - Country:US
Mailing Address - Phone:205-638-2230
Mailing Address - Fax:205-638-3559
Practice Address - Street 1:1208 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1311
Practice Address - Country:US
Practice Address - Phone:205-638-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist