MEDICARE: ETHAN NICHOLAS LEGGE

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	16529	TN

General Provider Information

NPI Number	:	1528944899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN NICHOLAS LEGGE

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-702-4389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 CRESTMOOR RD STE P1
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2051
Country	:	US
Telephone Number	:	615-942-9050
Fax Number	:

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/15/2025

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