Most Relevant Information
Provider Data
| NPI Number: | 1003414293 |
| Provider Name: | JACK WEAIR WOOTEN |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 2212 |
Most Important Dates
| Enumeration Date: | 10/12/2020 |
| Last Updated: | 10/12/2020 |
Provider Practice Location
2612 W HEIMAN ST APT D38
NASHVILLE
TN
372081818
Practice Location Phone/Fax
| Phone: | 6156865212 |
| Fax: |
Provider Mailing Location
2612 W HEIMAN ST APT D38
NASHVILLE
TN
372081818
Provider Mailing Phone/Fax
| Phone: | 6156865212 |
| Fax: |