Provider Demographics
NPI:1700038296
Name:THOROUGHMAN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:THOROUGHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:LYKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:1301 BRIDGESTONE PKWY
Practice Address - Street 2:
Practice Address - City:LAVERGNE
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-287-7340
Practice Address - Fax:615-287-7708
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid
TN4220815OtherBCBS OF TENNESSEE
TN3650218Medicare PIN
TN0446631Medicaid