Provider Demographics
NPI:1154545978
Name:PENTIAH, PATHMAVATHI S (PT)
Entity type:Individual
Prefix:
First Name:PATHMAVATHI
Middle Name:S
Last Name:PENTIAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0143
Mailing Address - Country:US
Mailing Address - Phone:423-310-0555
Mailing Address - Fax:423-396-2387
Practice Address - Street 1:108 LIFESTYLE WAY
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-3914
Practice Address - Country:US
Practice Address - Phone:423-339-2320
Practice Address - Fax:423-339-2321
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4129829OtherBCBS PROVIDER NO