Provider Demographics
NPI:1518920792
Name:OVERBY, ALLAN E (ATC)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:E
Last Name:OVERBY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COTHRON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1806
Mailing Address - Country:US
Mailing Address - Phone:615-714-1578
Mailing Address - Fax:
Practice Address - Street 1:312 FITE AVE E
Practice Address - Street 2:SMITH COUNTY HIGH SCHOOL
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1474
Practice Address - Country:US
Practice Address - Phone:615-714-1578
Practice Address - Fax:615-735-9049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000001592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer