Provider Demographics
NPI:1841314309
Name:HATHEWAY, NANETTE LYNN (PTA)
Entity type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:LYNN
Last Name:HATHEWAY
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 1:2514 FALLING LEAF COURT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130
Mailing Address - Country:US
Mailing Address - Phone:615-895-3548
Mailing Address - Fax:615-867-5223
Practice Address - Street 1:1927 MEMORIAL BLVD
Practice Address - Street 2:HEALTH CENTER AT ADAMS PLACE
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-904-9111
Practice Address - Fax:615-867-5223
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN330 PTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant