MEDICARE: DR. DUSTIN J FLOWERS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	0000004920	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000004920	OTHER	TN	OPERATING LICENSE

General Provider Information

NPI Number	:	1003950205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUSTIN J FLOWERS DPT

Provider Business Mailing Address
First Line	:	617 W MAIN ST
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462-1355
Country	:	US
Telephone Number	:	931-381-1111
Fax Number	:	931-380-4108

Provider Business Practice Location Address
First Line	:	617 W MAIN ST
Second Line	:
City	:	HOHENWALD
State	:	TN
Zip	:	38462-1355
Country	:	US
Telephone Number	:	931-381-1111
Fax Number	:	931-380-4108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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