Provider Demographics
NPI:1174688261
Name:FIELDS, JOHN LOWELL (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LOWELL
Last Name:FIELDS
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-285-6647
Practice Address - Street 1:3010 GAYLORD PKWY
Practice Address - Street 2:STE 140
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8664
Practice Address - Country:US
Practice Address - Phone:972-377-4111
Practice Address - Fax:972-337-4148
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2094863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant