Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 0000006194 | TN |
NPI | 1003354036 |
---|---|
Provider Name | Brian Meadow |
First Address | Dickson, TN 37055-1478 |
Second Address | Dickson, TN 37055-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 10/02/2017 |