Most Relevant Information
Provider Data
| NPI Number: | 1003466582 |
| Provider Name: | TIFFANY HAIRSTON PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 208100000X |
| Specialty: | Physical Medicine & Rehabilitation |
| License Number: | A4601 |
Most Important Dates
| Enumeration Date: | 09/16/2019 |
| Last Updated: | 09/16/2019 |
Provider Practice Location
2144 MAPLECREST DR
CHARLOTTE
NC
282126918
Practice Location Phone/Fax
| Phone: | 9802309405 |
| Fax: |
Provider Mailing Location
2144 MAPLECREST DR
CHARLOTTE
NC
282126918
Provider Mailing Phone/Fax
| Phone: | 9802309405 |
| Fax: |