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General NPI Number Information
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NPI Number | 1326581661
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Entity Type | Individual
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Provider Name | JACQUELINE PATRICE MCMICHEL PTA
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Gender | Female
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 1710 MAGNOLIA BLVD
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City | NASHVILLE
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State | TN
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Zip | 37212-3764
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Country | US
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Telephone | 615-383-2557
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Fax | 615-292-2061
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Provider Business Mailing Address
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Address Line | 1710 MAGNOLIA BLVD
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City | NASHVILLE
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State | TN
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Zip | 37212-3764
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Country | US
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Telephone | 615-383-2557
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Fax | 615-292-2061
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6016
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 06004354A
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License Number State | IN
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