Provider Demographics
NPI:1386709293
Name:ANTOS, TIFFANY ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:ANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4504
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81612-4504
Mailing Address - Country:US
Mailing Address - Phone:970-274-1293
Mailing Address - Fax:970-544-0775
Practice Address - Street 1:333 E DURANT AVE
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1839
Practice Address - Country:US
Practice Address - Phone:970-274-1293
Practice Address - Fax:970-544-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803948Medicare ID - Type Unspecified