Individual
MRS. MELANIE RUTH WORTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501A WESTFIELD PL, JASPER, TN 37347-5144
(423) 942-3009
(423) 942-3099
Mailing address
400 DIXIE LEE CENTER RD, KIMBALL, TN 37347-5672
(423) 837-7536
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2319
TN
225100000X
Physical Therapist
Primary
PT0000002319
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3110918
BLUECROSS BLUESHIELD OF T
TN
01
—
62-1407143
TAX IDENTIFICATION NUMBER
GA
01
—
621407143
TAX IDENTIFICATION NUMBER
TN
Enumeration date
05/19/2006
Last updated
10/30/2024
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