Provider Demographics
NPI:1588813489
Name:ROBERTSON, NANCY CAROL (LMT # 5257)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CAROL
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LMT # 5257
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:CAROL
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15285 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1803
Mailing Address - Country:US
Mailing Address - Phone:615-758-9333
Mailing Address - Fax:615-758-9335
Practice Address - Street 1:15285 LEBANON RD
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-1803
Practice Address - Country:US
Practice Address - Phone:615-758-9333
Practice Address - Fax:615-758-9335
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261766613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist