Healthcare Provider Details

I. General information

NPI: 1235754888
Provider Name (Legal Business Name): ROBERT HUTCHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 RIDGEWAY LOOP RD STE 100
MEMPHIS TN
38120-4026
US

IV. Provider business mailing address

2321 CHRISTOPHER CV
BARTLETT TN
38134-5773
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-1282
  • Fax:
Mailing address:
  • Phone: 901-734-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: