Provider Demographics
NPI:1649390907
Name:FORNABAIO, JOHN W JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:FORNABAIO
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:851 S WILLOW AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4221
Practice Address - Country:US
Practice Address - Phone:931-528-0042
Practice Address - Fax:931-528-0049
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2019-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY017936225100000X
TN10111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD0865Medicare PIN