Basic Information
| Provider Information | |||||||||
| NPI: | 1659896207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICH | ||||||||
| FirstName: | DUSTIN | ||||||||
| MiddleName: | CHASE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 S WILLOW AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385014668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315269518 | ||||||||
| FaxNumber: | 9313720087 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 TAYLOR STREET | ||||||||
| Address2: | |||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315269518 | ||||||||
| FaxNumber: | 9313720087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2017 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10312 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.