Provider Demographics
NPI:1417023854
Name:FATHY, ESSAM (RPT)
Entity Type:Individual
Prefix:MR
First Name:ESSAM
Middle Name:
Last Name:FATHY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COMMERCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3024
Mailing Address - Country:US
Mailing Address - Phone:615-459-9800
Mailing Address - Fax:615-459-2500
Practice Address - Street 1:211 COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3024
Practice Address - Country:US
Practice Address - Phone:615-459-9800
Practice Address - Fax:615-459-2500
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3106299OtherBCBS
TN3650570Medicare ID - Type Unspecified