Provider Demographics
NPI:1124355599
Name:SIA MORCILLO, DOROTHY (PHYSICIALTHERAPIST)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:SIA MORCILLO
Suffix:
Gender:F
Credentials:PHYSICIALTHERAPIST
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:SIA MORCILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAL THERAPIST
Mailing Address - Street 1:TENNESSEE SPORTS MEDICINE & ORTHOPAEDICS
Mailing Address - Street 2:5002 CROSSING CIRCLE SUITE 200
Mailing Address - City:MT. JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8471
Mailing Address - Country:US
Mailing Address - Phone:615-553-5500
Mailing Address - Fax:615-553-5501
Practice Address - Street 1:TENNESSEE SPORTS MEDICINE & ORTHOPAEDICS
Practice Address - Street 2:5002 CROSSING CIRCLE SUITE 200
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8471
Practice Address - Country:US
Practice Address - Phone:615-553-5500
Practice Address - Fax:615-553-5501
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723564OtherMEDICARE GROUP