Provider Demographics
NPI:1629647250
Name:NIXON, ANESSA LOR (DPT)
Entity Type:Individual
Prefix:MS
First Name:ANESSA
Middle Name:LOR
Last Name:NIXON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:705 S BROADWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1628
Mailing Address - Country:US
Mailing Address - Phone:615-325-9007
Mailing Address - Fax:615-325-5794
Practice Address - Street 1:12124 HWY 52 W
Practice Address - Street 2:SUITE D
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-9998
Practice Address - Country:US
Practice Address - Phone:615-644-6555
Practice Address - Fax:615-644-6557
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN009133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist