Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 6303 | TN |
NPI | 1003339672 |
---|---|
Provider Name | Patrick Wayne Dorris |
First Address | Madison, TN 37115-2357 |
Second Address | Madison, TN 37115-2357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 25/07/2017 |