Healthcare Provider Details

I. General information

NPI: 1851347371
Provider Name (Legal Business Name): RHONDA MILLER CALDWELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WOODLAWN AVE
DYERSBURG TN
38024-2028
US

IV. Provider business mailing address

1804 HIGHWAY 45 BYP SUITE 604
JACKSON TN
38305-4436
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-8759
  • Fax:
Mailing address:
  • Phone: 731-660-8759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: