Provider Demographics
NPI:1447732987
Name:YANCEY, TIFANI LEIGH (PTA)
Entity type:Individual
Prefix:
First Name:TIFANI
Middle Name:LEIGH
Last Name:YANCEY
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 1:300 CROWN POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1160
Mailing Address - Country:US
Mailing Address - Phone:817-757-1200
Mailing Address - Fax:
Practice Address - Street 1:300 CROWN POINTE BLVD
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-1160
Practice Address - Country:US
Practice Address - Phone:817-757-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2140858225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant