MEDICARE: CAROLYN WOMACK

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1573	OTHER	TN	LICENSE #

General Provider Information

NPI Number	:	1255441168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN WOMACK

Provider Business Mailing Address
First Line	:	624 POINT OF VIEW DR
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-9238
Country	:	US
Telephone Number	:	931-381-9940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 1/2 TROTWOOD AVE
Second Line	:	STE 100
City	:	COLUMBIA
State	:	TN
Zip	:	38401-6430
Country	:	US
Telephone Number	:	391-381-9940
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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Directions to “ CAROLYN WOMACK ” Practice Location

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