MEDICARE: PATRICIA GALE IRONS PT

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	5858	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4040559	OTHER	TN	BCBS OF TN

General Provider Information

NPI Number	:	1811076789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA GALE IRONS PT

Provider Business Mailing Address
First Line	:	3112 N OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312
Country	:	US
Telephone Number	:	423-554-1537
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 N OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312
Country	:	US
Telephone Number	:	423-554-1537
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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