Provider Demographics
NPI:1588126205
Name:TIFFANY BALTIERO LMT LLC
Entity type:Organization
Organization Name:TIFFANY BALTIERO LMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTIERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:904-405-8260
Mailing Address - Street 1:1286 MENNA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-8330
Mailing Address - Country:US
Mailing Address - Phone:904-405-8260
Mailing Address - Fax:
Practice Address - Street 1:2523 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4509
Practice Address - Country:US
Practice Address - Phone:904-405-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty