Healthcare Provider Details

I. General information

NPI: 1881642411
Provider Name (Legal Business Name): MARILOU HAREN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LOISE HAREN

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 AIRLINE RD STE 131
ARLINGTON TN
38002-9939
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 901-441-7997
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13635
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017471
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7274
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: