Provider Demographics
NPI:1699232124
Name:WHITEAKER, TIFFANY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WHITEAKER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2791
Mailing Address - Country:US
Mailing Address - Phone:469-446-0219
Mailing Address - Fax:
Practice Address - Street 1:12300 FRISCO ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3288
Practice Address - Country:US
Practice Address - Phone:463-633-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT53842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer