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General NPI Number Information
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NPI Number | 1821317413
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Entity Type | Individual
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Provider Name | JANICE DELORES FANSLER L.P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2010
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Last Update Date | 05/22/2010
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Provider Practice Location Address
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Address Line | 122 E FRANKLIN ST
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City | GALLATIN
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State | TN
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Zip | 37066-2828
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Country | US
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Telephone | 615-452-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 1076 LAKEWOOD DR
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City | GALLATIN
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State | TN
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Zip | 37066-8703
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Country | US
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Telephone | 615-404-0685
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Fax |
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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 | 0000000094
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License Number State | TN
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