Provider Demographics
NPI:1497402341
Name:MICKLEWRIGHT, ROBERT J (PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MICKLEWRIGHT
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 1:155 SERRAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3067
Mailing Address - Country:US
Mailing Address - Phone:423-798-0404
Mailing Address - Fax:
Practice Address - Street 1:155 SERRAL DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3067
Practice Address - Country:US
Practice Address - Phone:423-798-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5165225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant