| Organization Name: | NEBBEN PHYSICAL MEDICINE, LLC |
| NPI Number: | 1114317260 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOREN NEBBEN (OWNER) |
| Mailing Address: | 282 Clear Sky Ct Clarksville |
| State: | TN US |
| Postal Code: | 370435653 |
| Phone Number: | 9316471199 |
| Fax Number: | 9316477010 |
| NPI Enumeration Date: | 01/28/2015 |
| NPI Last Update Date: | 09/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 6465 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |