Healthcare Provider Details

I. General information

NPI: 1659955458
Provider Name (Legal Business Name): RAYMOND D LYSINGER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 JESS NEELY DR
NASHVILLE TN
37212-2039
US

IV. Provider business mailing address

2601 JESS NEELY DR
NASHVILLE TN
37212-2039
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-8769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: