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General NPI Number Information
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NPI Number | 1881332070
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Entity Type | Organization
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Legal Business Name | STAVEOFF TENNESSEE LLC
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 190D SAUNDERSVILLE RD STE 2002
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1008
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Country | US
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Telephone | 937-671-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 190D SAUNDERSVILLE RD STE 2002
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1008
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Country | US
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Telephone | 937-671-7600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHELBY LEIGH BLANKENSHIP
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Credential | PT, DPT
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Telephone | 615-669-4043
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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 |
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License Number State |
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