Provider Demographics
NPI:1902140403
Name:WOMACK, STEVE DOOLEY (PTA)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:DOOLEY
Last Name:WOMACK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 DAVIS LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3118
Mailing Address - Country:US
Mailing Address - Phone:423-562-0760
Mailing Address - Fax:423-562-1055
Practice Address - Street 1:136 DAVIS LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3118
Practice Address - Country:US
Practice Address - Phone:423-562-0760
Practice Address - Fax:423-562-1055
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant