Healthcare Provider Details

I. General information

NPI: 1902139058
Provider Name (Legal Business Name): MICHAEL FELTZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

IV. Provider business mailing address

1821 N WASHINGTON ST
TULLAHOMA TN
37388-2221
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-2005
  • Fax: 931-455-4450
Mailing address:
  • Phone: 931-455-2005
  • Fax: 931-455-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: