Provider Demographics
NPI:1750572210
Name:SPRINGER, KENNETH WAYNE
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:SPRINGER
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:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-0300
Mailing Address - Country:US
Mailing Address - Phone:731-364-6060
Mailing Address - Fax:731-364-6070
Practice Address - Street 1:130 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-1467
Practice Address - Country:US
Practice Address - Phone:731-364-6060
Practice Address - Fax:731-364-6070
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist