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Individual
TIFFANY DESIREA LIST
Active
Individual
TIFFANY DESIREA LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, PTA
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29516
FL
225700000X
Massage Therapist
MA72585
FL
Other
Enumeration date
05/13/2022
Last updated
05/13/2022
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