Provider Demographics
NPI:1215209036
Name:WOOTEN, TIMOTHY ANDY (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ANDY
Last Name:WOOTEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ROY MARTIN RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2244
Mailing Address - Country:US
Mailing Address - Phone:423-477-1101
Mailing Address - Fax:423-477-1102
Practice Address - Street 1:406 ROY MARTIN RD
Practice Address - Street 2:SUITE 9
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-2244
Practice Address - Country:US
Practice Address - Phone:423-477-1101
Practice Address - Fax:423-477-1102
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist