Tiffany Engle Avinger, MPT
Individual provider Active NPI Specialist · Shreveport, LA
NPI 1316130255 · NPPES record last updated Jun 9, 2020
Key facts
- NPI
- 1316130255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 06620 (LA)
- Practice address
- 510 E Stoner Ave
Shreveport, LA 71101-4243 - Phone
- (318) 221-8411
- NPI assigned
- Aug 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06620 | LA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 06620 | LA | Yes |
Addresses
Primary practice location
510 E Stoner Ave
Shreveport, LA 71101-4243
Mailing address
9819 Pennine CT
Shreveport, LA 71118-4841
Phone (318) 671-9034
Other names
- Mrs. Tiffany Adderley Bodenheimer
Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.