Provider Demographics
NPI:1871619544
Name:TUPA, TIFFANIE (PT)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:TUPA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1634
Mailing Address - Country:US
Mailing Address - Phone:210-558-4263
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1634
Practice Address - Country:US
Practice Address - Phone:210-558-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1123453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1252510001OtherMEDICARE NSC
TX8T4173OtherBCBS
TX1123453OtherPT STATE LICENSE
TXQ44964OtherUPIN NUMBER
TX8D5164Medicare UPIN
TX1123453OtherPT STATE LICENSE
TX8T4173OtherBCBS