1629385026 NPI number — REHAN HASAN DPT

Table of content: REHAN HASAN DPT (NPI 1629385026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629385026 NPI number — REHAN HASAN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASAN
Provider First Name:
REHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629385026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 681478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-1478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-591-6560
Provider Business Mailing Address Fax Number:
615-591-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2866 S CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37127-6374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-890-5051
Provider Business Practice Location Address Fax Number:
615-890-6411
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q003792 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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