Provider Demographics
NPI:1710702063
Name:SELF, ANNA OLIVIA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:OLIVIA
Last Name:SELF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 W END AVE STE 101F
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6877
Mailing Address - Country:US
Mailing Address - Phone:615-891-4037
Mailing Address - Fax:615-457-1796
Practice Address - Street 1:3415 W END AVE STE 101F
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-6877
Practice Address - Country:US
Practice Address - Phone:615-891-4037
Practice Address - Fax:615-457-1796
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist