Individual
MRS. TIFFANY HEATHER MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2037 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 529-3355
(208) 529-9581
Mailing address
2037 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 529-3355
(208) 529-9581
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA5326
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA5326
PROFESSIONAL LICENSE
ID
Enumeration date
04/24/2024
Last updated
09/29/2025
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