Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 6483 | TN |
Y | 2251P0200X | Physical Therapist - Pediatrics | 6483 | TN |
NPI | 1043308117 |
---|---|
Provider Name | Mrs. Kristin Mazzeo Garner |
First Address | Thompsons Station, TN 37179 |
Second Address | Brentwood, TN 37027-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 31/03/2009 |