Healthcare Provider Details

I. General information

NPI: 1508053877
Provider Name (Legal Business Name): JULIAN LERONE MAGEE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BRADFORD BLVD SUITE 500
GORDONSVILLE TN
38563-4600
US

IV. Provider business mailing address

112 BRADFORD BLVD SUITE 500
GORDONSVILLE TN
38563-4600
US

V. Phone/Fax

Practice location:
  • Phone: 615-683-3490
  • Fax: 615-683-3495
Mailing address:
  • Phone: 615-683-3490
  • Fax: 615-683-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH 5164
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10523
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: