Provider Demographics
NPI:1275370082
Name:WOMACK, WREN ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:WREN
Middle Name:ELIZABETH
Last Name:WOMACK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 MOBLEY WAY APT 304
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2296
Mailing Address - Country:US
Mailing Address - Phone:615-574-3375
Mailing Address - Fax:
Practice Address - Street 1:1826 AILOR AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5808
Practice Address - Country:US
Practice Address - Phone:865-524-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8351225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant