Provider Demographics
NPI:1871320473
Name:GARCIA, TIFFANY ANNE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANNE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANNE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4190 OLD PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5758
Mailing Address - Country:US
Mailing Address - Phone:804-382-5713
Mailing Address - Fax:
Practice Address - Street 1:110 SCOTTSVILLE CTR UNIT B
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24590-7001
Practice Address - Country:US
Practice Address - Phone:540-437-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605311225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant