| Doctor Name: | TIFFANY JO IDLEWINE |
| NPI Number: | 1740519248 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | 05009204A |
| Business Practice Address: | 5399 S Us Highway 41 Suite 113 Terre Haute, IN - 478024778 |
| Business Phone Number: | 8122988883 |
| Business Fax Number: | 8122988889 |
| Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
| State: | IL |
| Postal Code: | 604404909 |
| Phone Number: | 6302962223 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2009 |
| NPI Last Update Date: | 05/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 05009204A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |