Individual
TIFFANY VILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3088 LENOX RD NE, ATLANTA, GA 30324-2894
(404) 816-3991
Mailing address
3088 LENOX RD NE, ATLANTA, GA 30324-2894
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004065
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760437743
—
GA
Enumeration date
09/04/2018
Last updated
09/04/2018
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