Healthcare Provider Details

I. General information

NPI: 1083561245
Provider Name (Legal Business Name): ANITA MASTERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 W UNIVERSITY PKWY STE E
JACKSON TN
38305-1618
US

IV. Provider business mailing address

176 W UNIVERSITY PKWY STE E
JACKSON TN
38305-1618
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-3543
  • Fax: 731-300-4951
Mailing address:
  • Phone: 731-300-3543
  • Fax: 731-300-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8103
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: