Individual provider Active NPI

Tiffany Rose Delange, PT, DPT

  • Physical Therapist
  • Rockford, MI
National Provider Identifier
1184974065
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501015884 Issued in MI
Practice address
175 Marcell Drive
Rockford, MI 49341-1365
Phone
(616) 866-0141
Fax
(269) 375-9465
NPI assigned
Sep 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501015884 MI Primary

Addresses

Primary practice location

175 Marcell Drive
Rockford, MI 49341-1365

Mailing address

PO Box 30516
Dept 5300
Lansing, MI 48909-8016
Phone (269) 375-9450

Other names 1

  • Tiffany Thaler Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210505002522 MI Practitioner - Physical Therapist in Private Practice 0244649150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hulst Jepsen Physical Therapy IncGroup PAC ID 8325033285, 132 clinicians

Practice addresses (Care Compare)

175 Marcell Dr NE
Rockford, MI 49341-1365
Phone (616) 866-0141

2120 43Rd St SE
Suite 100
Grand Rapids, MI 49508-3712
Phone (616) 281-1144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hulst Jepsen Physical Therapy Inc Physical Therapist CurrentSince Apr 27, 2021 Accepting new patients
Physiotherapy Associates Inc Past Accepting new patients

Locations

2120 43rd St SE
Ste 100
Grand Rapids, MI 49508
Phone (616) 281-1144

4761 Lake Michigan Dr NW
Ste A
Grand Rapids, MI 49534
Phone (616) 608-9978

175 Marcell Dr NE
Rockford, MI 49341
Phone (616) 866-0141

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1184974065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30516",
            "address_2": "DEPT 5300",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489098016",
            "telephone_number": "269-375-9450",
            "fax_number": "269-375-9465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MARCELL DRIVE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493411365",
            "telephone_number": "616-866-0141",
            "fax_number": "269-375-9465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELANGE",
        "first_name": "TIFFANY",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501015884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "THALER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.