Healthcare Provider Details

I. General information

NPI: 1962984278
Provider Name (Legal Business Name): RAYMOND MICHAEL SLIFKA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W BADDOUR PKWY STE 120
LEBANON TN
37087-1510
US

IV. Provider business mailing address

PO BOX 306393
NASHVILLE TN
37230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 615-443-9036
  • Fax: 615-443-9037
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11786
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: