Healthcare Provider Details

I. General information

NPI: 1073196606
Provider Name (Legal Business Name): JENERGY FOR LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/02/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RED MILE RD
MURFREESBORO TN
37127-6689
US

IV. Provider business mailing address

2301 RED MILE RD
MURFREESBORO TN
37127-6689
US

V. Phone/Fax

Practice location:
  • Phone: 423-258-4678
  • Fax:
Mailing address:
  • Phone: 423-258-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENNIFER DICKENS MASSIE
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 423-258-4678