Provider Demographics
NPI:1760971121
Name:CREASY, TONYA D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:D
Last Name:CREASY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-0629
Mailing Address - Country:US
Mailing Address - Phone:615-666-5095
Mailing Address - Fax:615-666-2254
Practice Address - Street 1:505 ELLINGTON DR STE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1074
Practice Address - Country:US
Practice Address - Phone:615-666-5095
Practice Address - Fax:615-666-2254
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist