Provider Demographics
NPI:1639423668
Name:TISDALE, MEGAN MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MARIE
Last Name:TISDALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:HELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:5073 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2738
Practice Address - Country:US
Practice Address - Phone:615-302-3564
Practice Address - Fax:615-302-3067
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist