1154459295 NPI number — MRS. KAY J MYERS PHYSICAL THERAPIST

Table of content: MRS. KAY J MYERS PHYSICAL THERAPIST (NPI 1154459295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154459295 NPI number — MRS. KAY J MYERS PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
KAY
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYERS
Provider Other First Name:
SUSAN
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154459295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 GOLF CLUB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCMINNVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-668-5008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 FISHER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-597-4284
Provider Business Practice Location Address Fax Number:
615-597-0734
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  TN1293 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com