Provider Demographics
NPI:1285748665
Name:HUMBERGER, NANCY WILLIAMS (PT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:WILLIAMS
Last Name:HUMBERGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:PATRICIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2255 CENTER STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-855-0745
Mailing Address - Fax:423-855-7898
Practice Address - Street 1:2255 CENTER STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-855-0745
Practice Address - Fax:423-855-7898
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4103517OtherBLUE CROSS OF TENNESSEE
TN3650553Medicare ID - Type Unspecified