Provider Demographics
NPI:1427283688
Name:WITCHER, FAY WENDELL II (CRT, RPSGT)
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:WENDELL
Last Name:WITCHER
Suffix:II
Gender:M
Credentials:CRT, RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2961
Mailing Address - Country:US
Mailing Address - Phone:615-575-4176
Mailing Address - Fax:615-452-9652
Practice Address - Street 1:258 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2961
Practice Address - Country:US
Practice Address - Phone:615-575-4176
Practice Address - Fax:615-452-9652
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCRT00000031662278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care