Active NPI
Micah Vailes
- Physical Therapist
- Cookeville, TN
National Provider Identifier
1952010621
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13786
- Practice address
- 675 S Jefferson Ave Ste C
Cookeville, TN 38501-0949 - Phone
- (931) 528-8822
- NPI assigned
- Nov 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 13786 | TN | Primary |
Addresses
Primary practice location
675 S Jefferson Ave Ste C
Cookeville, TN 38501-0949
Mailing address
675 S Jefferson Ave Ste C
Cookeville, TN 38501-0949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13786 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684281600000",
"number": "1952010621",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 S JEFFERSON AVE STE C",
"city": "COOKEVILLE",
"state": "TN",
"postal_code": "385010949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 S JEFFERSON AVE STE C",
"city": "COOKEVILLE",
"state": "TN",
"postal_code": "385010949",
"telephone_number": "931-528-8822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAILES",
"first_name": "MICAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-11-21",
"last_updated": "2023-05-17",
"certification_date": "2023-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "13786",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cookeville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.