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Individual
MRS. TIFFANI S BACON
Active
Individual
MRS. TIFFANI S BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10015
SC
225100000X
Physical Therapist
9900
NC
225100000X
Physical Therapist
Primary
CP039211T-MD
MD
2251P0200X
Pediatric Physical Therapist
10015
SC
2251P0200X
Pediatric Physical Therapist
9900
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP039211T-MD
COMPACT PT LICENSURE
MD
01
—
P00405932
RAILROAD MEDICARE
—
05
—
TH2249
—
SC
Enumeration date
12/22/2006
Last updated
03/15/2026
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