MEDICARE: MARISSA LYNN DYLING PTA

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	225200000X	Physical Therapy Assistant	5526	TN

General Provider Information

NPI Number	:	1790105294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LYNN DYLING PTA

Provider Business Mailing Address
First Line	:	3717 WINDMILL CT
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-1301
Country	:	US
Telephone Number	:	609-802-4621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 BELCOURT AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3717
Country	:	US
Telephone Number	:	615-383-3570
Fax Number	:

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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