Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT2116 | TN |
NPI | 1407040066 |
---|---|
Provider Name | Marissa S Carnes |
First Address | Knoxville, TN 37931-3683 |
Second Address | Knoxville, TN 37916-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |