Provider Demographics
NPI:1902213622
Name:BIRD, NICHOLAS TYSON (MPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TYSON
Last Name:BIRD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 WOLF RIVER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1773
Mailing Address - Country:US
Mailing Address - Phone:015-226-4409
Mailing Address - Fax:901-757-2507
Practice Address - Street 1:8040 WOLF RIVER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1773
Practice Address - Country:US
Practice Address - Phone:015-226-4409
Practice Address - Fax:901-757-2507
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist