Healthcare Provider Details

I. General information

NPI: 1336470004
Provider Name (Legal Business Name): JORGE OCTAVIO ROJAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 MALLORY LN
FRANKLIN TN
37067
US

IV. Provider business mailing address

4095 MALLORY LN
FRANKLIN TN
37067-8268
US

V. Phone/Fax

Practice location:
  • Phone: 615-516-3164
  • Fax:
Mailing address:
  • Phone: 615-516-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number8759
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: