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General NPI Number Information
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NPI Number | 1760420426
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 1030 JEFFERSON AVE (117RT)
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City | MEMPHIS
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State | TN
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Zip | 38104-2127
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Country | US
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Telephone | 901-523-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 1153 GREENVIEW RD
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City | COLLIERVILLE
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State | TN
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Zip | 38017-6884
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RECREATION THERAPIST
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Name | MELISSA COOK
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Credential |
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Telephone | 901-523-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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