Individual
MR. BOBBY GENE MANOR II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
162 HICKORY TRCE, LYLES, TN 37098-9663
(931) 670-4849
Mailing address
162 HICKORY TRCE, LYLES, TN 37098-9663
(937) 670-4849
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2012
TN
Other
Enumeration date
09/26/2006
Last updated
07/08/2007
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