Provider Demographics
NPI:1336582915
Name:REID, JEROME JOSEPH (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:JOSEPH
Last Name:REID
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 HIGHWAY 70 S
Mailing Address - Street 2:UNIT 406
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-5235
Mailing Address - Country:US
Mailing Address - Phone:804-605-4535
Mailing Address - Fax:
Practice Address - Street 1:460 GREAT CIRCLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1404
Practice Address - Country:US
Practice Address - Phone:605-565-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer