Healthcare Provider Details

I. General information

NPI: 1801093372
Provider Name (Legal Business Name): NELSON ANTHONY LIWAG PTA, LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 S DICKERSON RD
GOODLETTSVILLE TN
37072-1761
US

IV. Provider business mailing address

120 WINDHAM CIRCLE
HENDERSONVILLE TN
37075
US

V. Phone/Fax

Practice location:
  • Phone: 615-859-6600
  • Fax: 615-859-6608
Mailing address:
  • Phone: 615-826-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2319
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: