Provider Demographics
NPI:1821317413
Name:FANSLER, JANICE DELORES (LPTA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:DELORES
Last Name:FANSLER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8703
Mailing Address - Country:US
Mailing Address - Phone:615-404-0685
Mailing Address - Fax:
Practice Address - Street 1:122 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2828
Practice Address - Country:US
Practice Address - Phone:615-452-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000094225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant