Healthcare Provider Details

I. General information

NPI: 1942547377
Provider Name (Legal Business Name): CYNTHIA ANN STANAWAY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 GUNBARREL RD STE 103
CHATTANOOGA TN
37421-7244
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-892-8070
  • Fax: 423-893-9891
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3756
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: