Provider Demographics
NPI:1629025689
Name:CANTRELL, NIXON HALL (PT)
Entity Type:Individual
Prefix:
First Name:NIXON
Middle Name:HALL
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8923
Mailing Address - Fax:423-954-7399
Practice Address - Street 1:275 JACKSON MEADOWS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1426
Practice Address - Country:US
Practice Address - Phone:615-885-7848
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732254Medicaid
TN3732254Medicaid