Provider Demographics
NPI:1992940035
Name:ZAMUDIO, JAN C (MPT)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:C
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 EDMONDSON PIKE STE 114
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5871
Mailing Address - Country:US
Mailing Address - Phone:615-833-6882
Mailing Address - Fax:
Practice Address - Street 1:5515 EDMONDSON PIKE STE 114
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5871
Practice Address - Country:US
Practice Address - Phone:615-833-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist