Provider Demographics
NPI:1811032741
Name:MAUPIN, PATRICK MICHAEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:MAUPIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220B E BIGGS RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4892
Mailing Address - Country:US
Mailing Address - Phone:615-477-1103
Mailing Address - Fax:
Practice Address - Street 1:121 VILLAGE DR STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1418
Practice Address - Country:US
Practice Address - Phone:615-323-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000003830225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant