Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8868 | TN |
NPI | 1003112285 |
---|---|
Provider Name | Richard Bradford Atlee |
First Address | Mountain Home, TN 37684-4000 |
Second Address | Mountain Home, TN 37684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2011 |
Last Update Date | 04/02/2011 |