Provider Demographics
NPI:1780708636
Name:REEVES, DOROTHY LYN (P T)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:LYN
Last Name:REEVES
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROOKTON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:TN
Mailing Address - Zip Code:37645-4034
Mailing Address - Country:US
Mailing Address - Phone:423-245-1687
Mailing Address - Fax:
Practice Address - Street 1:1500 BROOKTON DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:TN
Practice Address - Zip Code:37645-4034
Practice Address - Country:US
Practice Address - Phone:423-245-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPT0000000783OtherPHYSICAL THERAPIST