Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 10851 | NC |
N | 225100000X | Physical Therapist | 5233 | SC |
Y | 225100000X | Physical Therapist | 5564 | TN |
NPI | 1003099649 |
---|---|
Provider Name | Ms. Suzanne Grace |
First Address | Knoxville, TN 37922-3355 |
Second Address | Knoxville, TN 37922-3355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 20/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1512782 | (05) | TN |
4223417 | BLUECROSS BLUESHIELD (01) | TN |
P00747042 | RAILROAD MEDICARE (01) |