Healthcare Provider Details

I. General information

NPI: 1194167866
Provider Name (Legal Business Name): LEE ANN CHEATHAM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N MOUNT JULIET RD SUITE 1101
MOUNT JULIET TN
37122-3312
US

IV. Provider business mailing address

545 N MOUNT JULIET RD SUITE 1101
MOUNT JULIET TN
37122-3312
US

V. Phone/Fax

Practice location:
  • Phone: 615-553-4645
  • Fax: 615-553-4794
Mailing address:
  • Phone: 615-553-4645
  • Fax: 615-553-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9692
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: