Healthcare Provider Details

I. General information

NPI: 1992012421
Provider Name (Legal Business Name): ROSS MILEY FLYNT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 NEW COVINGTON PIKE SUITE 108
MEMPHIS TN
38128-2500
US

IV. Provider business mailing address

3980 NEW COVINGTON PIKE SUITE 108
MEMPHIS TN
38128-2500
US

V. Phone/Fax

Practice location:
  • Phone: 901-937-3200
  • Fax: 901-383-1738
Mailing address:
  • Phone: 901-937-3200
  • Fax: 901-383-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8784
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: