Gretchen Dene Etheredge, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4695 Issued in TN

Practice address

1018 W Main St
Lebanon, TN 37087-3302

Phone

(615) 466-5200

Fax

(615) 466-5206

NPI assigned

Aug 9, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189641600000",
    "number": "1720089196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 W MAIN ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873100",
            "telephone_number": "615-449-0990",
            "fax_number": "615-449-0970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 W MAIN ST",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873302",
            "telephone_number": "615-466-5200",
            "fax_number": "615-466-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHEREDGE",
        "first_name": "GRETCHEN",
        "middle_name": "DENE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2007-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "4695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3645491",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.