Healthcare Provider Details

I. General information

NPI: 1558857896
Provider Name (Legal Business Name): ZACHARY SEXTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LONG HOLLOW PIKE STE 104
GOODLETTSVILLE TN
37072-1848
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 615-859-3852
  • Fax: 615-859-6712
Mailing address:
  • Phone: 423-238-7568
  • Fax: 615-656-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11833
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: