Individual
GRETCHEN DENE ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1018 W MAIN ST, LEBANON, TN 37087-3302
(615) 466-5200
(615) 466-5206
Mailing address
1616 W MAIN ST, LEBANON, TN 37087-3100
(615) 449-0990
(615) 449-0970
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4695
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3645491
—
TN
Enumeration date
08/09/2005
Last updated
09/13/2007
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