Healthcare Provider Details

I. General information

NPI: 1356259675
Provider Name (Legal Business Name): BRETT RYAN MICHUM PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 W CHURCH ST
LEXINGTON TN
38351-2096
US

IV. Provider business mailing address

11876 N NEW HOPE RD
DARDANELLE AR
72834-7778
US

V. Phone/Fax

Practice location:
  • Phone: 731-967-3788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5917
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: