Healthcare Provider Details

I. General information

NPI: 1275244329
Provider Name (Legal Business Name): SADDLED SOULS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VAUGHAN RD
CLARKSVILLE TN
37043-5321
US

IV. Provider business mailing address

900 VAUGHAN RD
CLARKSVILLE TN
37043-5321
US

V. Phone/Fax

Practice location:
  • Phone: 931-216-9095
  • Fax:
Mailing address:
  • Phone: 931-216-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CROCKER
Title or Position: OWNER
Credential:
Phone: 931-216-9095