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NPI Code Detail

MEDICARE: MRS. PAULINE HENDREN LPTA

MEDICARE: MRS. PAULINE HENDREN LPTA
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
1225200000XPhysical Therapy Assistant3874658TN

General Provider Information

NPI Number : 1861606196
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PAULINE HENDREN LPTA
Provider Business Mailing Address
First Line : 360 HARMON LN
Second Line :
City : LAKE CITY
State : TN
Zip : 37769-5335
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3131 TOM AUSTIN HWY
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-4801
Country : US
Telephone Number : 615-386-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. PAULINE HENDREN LPTA” Practice Location

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