Provider Demographics
NPI:1528159548
Name:WORTMAN, FRED AUSTON III (PT, ATC, JD)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:AUSTON
Last Name:WORTMAN
Suffix:III
Gender:M
Credentials:PT, ATC, JD
Other - Prefix:
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Mailing Address - Street 1:487 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2315
Mailing Address - Country:US
Mailing Address - Phone:901-860-9271
Mailing Address - Fax:901-860-9271
Practice Address - Street 1:1789 KIRBY PKWY
Practice Address - Street 2:SUITE #3
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3608
Practice Address - Country:US
Practice Address - Phone:901-759-1282
Practice Address - Fax:901-759-1290
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN6624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist