Provider Demographics
NPI:1649348053
Name:HAUPERT, TOMMY (PT)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:HAUPERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 SUGAR PINE DR
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-8959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17919 RANKIN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7040
Practice Address - Country:US
Practice Address - Phone:423-949-7899
Practice Address - Fax:423-949-3416
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist