Provider Demographics
NPI:1669110011
Name:ALCORN, PHILLIP JORDAN
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JORDAN
Last Name:ALCORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 GIBBONS RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5060
Mailing Address - Country:US
Mailing Address - Phone:931-510-1409
Mailing Address - Fax:
Practice Address - Street 1:318 BILBREY ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1706
Practice Address - Country:US
Practice Address - Phone:931-823-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist