Provider Demographics
NPI:1538431671
Name:STINSON, DAWN MICHELLE (PTA)
Entity type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:MICHELLE
Last Name:STINSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4427
Mailing Address - Country:US
Mailing Address - Phone:615-202-3815
Mailing Address - Fax:
Practice Address - Street 1:923 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1691
Practice Address - Country:US
Practice Address - Phone:615-323-7575
Practice Address - Fax:615-323-0677
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant