Provider Demographics
NPI:1194156331
Name:FLETCHER, AUTUMN CHANEL (DPT)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:CHANEL
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:CHANEL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:104 BURWELL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-8699
Mailing Address - Country:US
Mailing Address - Phone:256-468-0917
Mailing Address - Fax:256-351-5016
Practice Address - Street 1:8475 WANN DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-539-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist