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General NPI Number Information
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NPI Number | 1649390907
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Entity Type | Individual
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Provider Name | JOHN W FORNABAIO JR. P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 851 S WILLOW AVE SUITE 110
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City | COOKEVILLE
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State | TN
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Zip | 38501-4221
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Country | US
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Telephone | 931-528-0042
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Fax | 931-528-0049
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Provider Business Mailing Address
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Address Line | 800 CRESCENT CENTRE DR STE 300
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City | FRANKLIN
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State | TN
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Zip | 37067-7285
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Country | US
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Telephone | 615-373-1350
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Fax | 615-221-9054
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 017936
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10111
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License Number State | TN
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