Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5224 | TN |
NPI | 1013452259 |
---|---|
Provider Name | Mr. Ashley Johnson |
First Address | Gallatin, TN 37066-1509 |
Second Address | Gallatin, TN 37066-1509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2016 |
Last Update Date | 26/12/2016 |