| Doctor Name: | TIFFANY A THERIAULT |
| NPI Number: | 1356663595 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MT |
| License Number: | |
| Business Practice Address: | 16801 Newburgh Rd Ste 114 Livonia, MI - 481541606 |
| Business Phone Number: | 2489103644 |
| Business Fax Number: | 2487737035 |
| Mailing Address: | 5000 Town Ctr Ste 2001, SOUTHFIELD |
| State: | MI |
| Postal Code: | 480751116 |
| Phone Number: | 2483520314 |
| Fax Number: | 2482810759 |
| NPI Enumeration Date: | 02/15/2010 |
| NPI Last Update Date: | 02/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |