Provider Demographics
NPI:1649477449
Name:ENOCH, CHRISTIN EDONNA (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:EDONNA
Last Name:ENOCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:EDONNA
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:301 CULLUM ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1301
Mailing Address - Country:US
Mailing Address - Phone:615-489-6861
Mailing Address - Fax:
Practice Address - Street 1:1927 MEMORIAL BLVD
Practice Address - Street 2:ADAMS PLACE
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-904-9111
Practice Address - Fax:615-867-5223
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4026225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant