Provider Demographics
NPI:1952936924
Name:BYDLINSKI, PHINLEY (CNIM, REEGT)
Entity Type:Individual
Prefix:
First Name:PHINLEY
Middle Name:
Last Name:BYDLINSKI
Suffix:
Gender:M
Credentials:CNIM, REEGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 PARSONS POND DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8868
Mailing Address - Country:US
Mailing Address - Phone:678-467-1741
Mailing Address - Fax:
Practice Address - Street 1:750 OLD HICKORY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5387
Practice Address - Country:US
Practice Address - Phone:484-351-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4154246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic