Provider Demographics
NPI:1124116769
Name:GIVENS, ELSIE BELLE (PT)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:BELLE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:BELLE
Other - Last Name:MCKISSACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1245 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-4173
Mailing Address - Country:US
Mailing Address - Phone:615-740-9907
Mailing Address - Fax:
Practice Address - Street 1:812 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1009
Practice Address - Country:US
Practice Address - Phone:615-446-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6909OtherPT LICENSE