Doctor Name: | TIFFANY C. JACKSON |
NPI Number: | 1619289212 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T. |
License Number: | 6077621-4701 |
Business Practice Address: | 904 S Main St Pleasant Grove, UT - 840623560 |
Business Phone Number: | 8016873957 |
Business Fax Number: | |
Mailing Address: | 904 S Main St, PLEASANT GROVE |
State: | UT |
Postal Code: | 840623560 |
Phone Number: | 8016873957 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2010 |
NPI Last Update Date: | 02/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 6077621-4701 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
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. |