Provider Demographics
NPI:1992516934
Name:MOLLICONI, TIFFANY (PTA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MOLLICONI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16570 SHOSHONE PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8887
Mailing Address - Country:US
Mailing Address - Phone:251-752-3733
Mailing Address - Fax:855-678-8887
Practice Address - Street 1:16570 SHOSHONE PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8887
Practice Address - Country:US
Practice Address - Phone:251-752-3733
Practice Address - Fax:855-678-8887
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00015618225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant