MEDICARE: AUSTIN DAUGHERTY

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	12304	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447813969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN DAUGHERTY

Provider Business Mailing Address
First Line	:	PO BOX 681478
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-1478
Country	:	US
Telephone Number	:	615-591-6590
Fax Number	:	615-591-6601

Provider Business Practice Location Address
First Line	:	7016 CITY CENTER WAY
Second Line	:
City	:	FAIRVIEW
State	:	TN
Zip	:	37062-6004
Country	:	US
Telephone Number	:	615-799-1915
Fax Number	:	615-799-5928

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

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	10/28/2019

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Directions to “ AUSTIN DAUGHERTY ” Practice Location

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