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General NPI Number Information
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NPI Number | 1902377948
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Entity Type | Organization
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Legal Business Name | TOM EVANS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 244 JACKSON MEADOWS DR
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City | HERMITAGE
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State | TN
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Zip | 37076-1425
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Country | US
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Telephone | 615-874-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 244 JACKSON MEADOWS DR
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City | HERMITAGE
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State | TN
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Zip | 37076-1425
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Country | US
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Telephone | 615-874-9888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS DALE EVANS
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Credential | PT, ATC
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Telephone | 334-332-9044
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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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