Provider Demographics
NPI:1437323276
Name:PRINCE, WILMA RUTH (LMT)
Entity Type:Individual
Prefix:MS
First Name:WILMA
Middle Name:RUTH
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37011-0488
Mailing Address - Country:US
Mailing Address - Phone:615-365-7810
Mailing Address - Fax:615-467-6671
Practice Address - Street 1:566 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013
Practice Address - Country:US
Practice Address - Phone:615-365-7810
Practice Address - Fax:615-467-6671
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist