Individual
EVAN CORWYN EAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
670 SKYLINE DR, JACKSON, TN 38301-3934
(731) 300-4800
(731) 300-4862
Mailing address
670 SKYLINE DR, JACKSON, TN 38301-3934
(731) 300-4800
(731) 300-4862
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0000005722
TN
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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