Healthcare Provider Details

I. General information

NPI: 1104248707
Provider Name (Legal Business Name): BENJAMIN OWNBY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 MELVIN JONES DR
NASHVILLE TN
37217-3112
US

IV. Provider business mailing address

320 MELVIN JONES DR
NASHVILLE TN
37217-3112
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-9093
  • Fax:
Mailing address:
  • Phone: 615-499-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8145
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: