Healthcare Provider Details

I. General information

NPI: 1144888116
Provider Name (Legal Business Name): FABIOLA ESCOBAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 RHINO CROSSING
MILAN TN
38358
US

IV. Provider business mailing address

PO BOX 1004
MILAN TN
38358-1004
US

V. Phone/Fax

Practice location:
  • Phone: 731-613-2214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11858
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: