Provider Demographics
NPI:1265771083
Name:CULPEPPER, GLORIA M (PTA)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:M
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 TEABERRY CT
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8359
Mailing Address - Country:US
Mailing Address - Phone:423-521-4160
Mailing Address - Fax:
Practice Address - Street 1:7236 TEABERRY CT
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8359
Practice Address - Country:US
Practice Address - Phone:423-521-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000000711225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant