Provider Demographics
NPI:1689891186
Name:TARA L HEWLETT-BRYANT
Entity Type:Organization
Organization Name:TARA L HEWLETT-BRYANT
Other - Org Name:FIT 2 A T
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERCEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LAZETTE
Authorized Official - Last Name:HEWLETTBRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-504-1595
Mailing Address - Street 1:557 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2233
Mailing Address - Country:US
Mailing Address - Phone:423-624-9813
Mailing Address - Fax:423-624-9813
Practice Address - Street 1:557 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2233
Practice Address - Country:US
Practice Address - Phone:423-624-9813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier