Individual
MISS TIFFANY MARIE KORRER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1100 A. STREET, PLUMMER, ID 83851
(208) 686-7041
(208) 686-5712
Mailing address
P.O. BOX 516, PLUMMER, ID 83851
(208) 686-7041
(208) 686-5712
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2740
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807854400
—
ID
Enumeration date
01/19/2011
Last updated
01/19/2011
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