Provider Demographics
NPI:1548718372
Name:FEWELL, TOSHA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:TOSHA
Middle Name:MARIE
Last Name:FEWELL
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 1:2400 PATTERSON ST
Mailing Address - Street 2:ST. 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-342-0265
Mailing Address - Fax:
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:ST. 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-342-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4969225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant