Provider Demographics
NPI:1053693390
Name:RENWICK, TIFFANY LYNN MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LYNN MARIE
Last Name:RENWICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 E BASELINE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4638
Mailing Address - Country:US
Mailing Address - Phone:480-807-6500
Mailing Address - Fax:480-897-2700
Practice Address - Street 1:3950 E RIGGS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5410
Practice Address - Country:US
Practice Address - Phone:480-807-6500
Practice Address - Fax:480-897-2700
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist