Basic Information
| Provider Information | |||||||||
| NPI: | 1194167866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEATHAM | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 N MOUNT JULIET RD | ||||||||
| Address2: | SUITE 1101 | ||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371223312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155534645 | ||||||||
| FaxNumber: | 6155534794 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 N MOUNT JULIET RD | ||||||||
| Address2: | SUITE 1101 | ||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371223312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155534645 | ||||||||
| FaxNumber: | 6155534794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2013 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9692 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.