Basic Information
| Provider Information | |||||||||
| NPI: | 1386123198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOWNING | ||||||||
| FirstName: | TATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 382 LONG RD | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421047402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705359760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1595 US HWY 31 S | ||||||||
| Address2: | |||||||||
| City: | BEAVER DAM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775083237 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 007454 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.