Healthcare Provider Details

I. General information

NPI: 1386123198
Provider Name (Legal Business Name): TATE DOWNING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 US HWY 31 S
BEAVER DAM KY
42320
US

IV. Provider business mailing address

382 LONG RD
BOWLING GREEN KY
42104-7402
US

V. Phone/Fax

Practice location:
  • Phone: 877-508-3237
  • Fax:
Mailing address:
  • Phone: 270-535-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007454
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: