Healthcare Provider Details

I. General information

NPI: 1225977762
Provider Name (Legal Business Name): AMY BOCKMON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY FARRIS

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 DAYTON BLVD APT A
RED BANK TN
37415-4646
US

IV. Provider business mailing address

3404 DAYTON BLVD APT A
RED BANK TN
37415-4646
US

V. Phone/Fax

Practice location:
  • Phone: 423-994-2993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6868
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: