Healthcare Provider Details

I. General information

NPI: 1154013795
Provider Name (Legal Business Name): MARYANN L FENNER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 SAND HILL RD STE 101
CANDLER NC
28715-0470
US

IV. Provider business mailing address

239 E KINGSTON SPRINGS RD
KINGSTON SPRINGS TN
37082-8916
US

V. Phone/Fax

Practice location:
  • Phone: 828-552-5342
  • Fax: 828-641-9303
Mailing address:
  • Phone: 615-418-3783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP042448T
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051583T
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13793
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP030184T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: