MEDICARE: HEALING FORMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1699750414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING FORMS

Provider Business Mailing Address
First Line	:	60 LONG AVE
Second Line	:
City	:	PARSONS
State	:	TN
Zip	:	38363-2429
Country	:	US
Telephone Number	:	731-847-3676
Fax Number	:	731-847-3296

Provider Business Practice Location Address
First Line	:	60 LONG AVE
Second Line	:
City	:	PARSONS
State	:	TN
Zip	:	38363-2429
Country	:	US
Telephone Number	:	731-847-3676
Fax Number	:	731-847-3296

Authorized Official
Title or Position	:	OWNER
Name	:	DIANA MONTGOMERY
Credential	:
Telephone Number	:	731-847-3676

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1336148808 — MRS. DIANA LYNN MONTGOMERY
Practice Location Address:

60 LONG AVE
PARSONS, TN
38363-2429

Practice Phone: 731-847-3676
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1073752424 — KRISTEN NICOLE ALEXANDER D.C.
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1316256993 — KIMBERLY INMAN FNP-C
Practice Location Address:

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1538095153 — FOUNDATION FOR WELLNESS
Practice Location Address:

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1700367091 — CYNTHIA HINSON CARROLL NP-C
Practice Location Address:

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1114928173 — DR. VICKIE C SUMMERS D.PH.
Practice Location Address:

179 TENNESSEE AVE N
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Directions to “HEALING FORMS ” Practice Location

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