Provider Demographics
NPI:1487786562
Name:NGUYEN, TIFFANY NMN (DPT)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:NMN
Last Name:NGUYEN
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 1:2215 NE 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4111
Mailing Address - Country:US
Mailing Address - Phone:714-420-0551
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST STE 104
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist