Provider Demographics
NPI:1720151442
Name:FATHY, SAFAA (RPT)
Entity type:Individual
Prefix:MRS
First Name:SAFAA
Middle Name:
Last Name:FATHY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 E BURTON ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3855
Mailing Address - Country:US
Mailing Address - Phone:615-896-8500
Mailing Address - Fax:615-895-9551
Practice Address - Street 1:433 E BURTON ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3855
Practice Address - Country:US
Practice Address - Phone:615-896-8500
Practice Address - Fax:615-895-9551
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2200485OtherBCBS
TN5827004OtherAETNA
TN64-40023OtherUNITED HEALTHCARE
TN0446539Medicaid
TN2200485OtherBCBS