Provider Demographics
NPI:1164825766
Name:FONTENOT, SHAY MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:SHAY
Middle Name:MICHAEL
Last Name:FONTENOT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 BRITISH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3356
Mailing Address - Country:US
Mailing Address - Phone:337-329-0657
Mailing Address - Fax:
Practice Address - Street 1:1035 FULTON GREER RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2080
Practice Address - Country:US
Practice Address - Phone:615-592-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8881225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant