Healthcare Provider Details

I. General information

NPI: 1740834159
Provider Name (Legal Business Name): SKYLAR MEFFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 HUNTSVILLE HWY
FAYETTEVILLE TN
37334-3606
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 931-438-6335
  • Fax: 931-438-6337
Mailing address:
  • Phone: 423-238-8930
  • Fax: 423-254-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12515
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: